NPIMap

Organization Active NPI

Graham Hospital Association

Doing business as Graham Medical Group Williamsfield

  • Rural Health Clinic/Center
  • Williamsfield, IL
National Provider Identifier
1508463563
Registry record updated Apr 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GRAHAM HOSPITAL ASSOCIATION
Doing business as
Graham Medical Group Williamsfield
Practice address
120 E Gale St
Williamsfield, IL 61489-5418
Phone
(309) 639-4004
Fax
(309) 639-4065
NPI assigned
Oct 2, 2020
Last updated
Apr 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 3, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Janelle M Postin
Title
Credentialing Specialist
Phone
(309) 647-5240

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

120 E Gale St
Williamsfield, IL 61489-5418

Mailing address

180 S Main St
Canton, IL 61520-2608
Phone (309) 647-0201

Other names 1

  • Graham Medical Group Williamsfield Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040510000873 IL Part B Supplier - Clinic/Group Practice 2769375021 Receives reassigned benefits from 139 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Galesburg, IL; Williamsfield, IL; Macomb, IL; Lewistown, IL; Glasford, IL; Farmington, IL; Elmwood, IL; Canton, IL
O20220725002615 IL Part A Provider - Rural Health Clinic 2769375021 Practice locations: Williamsfield, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508463563. Details of each certification follow.

Rural health clinic certification: CCN 148636

Legal name
GRAHAM HOSPITAL ASSOCIATION
Doing business as
GRAHAM MEDICAL GROUP-WILLIAMSFIELD
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 17, 2023
Last certification
Feb 17, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Oct 16, 1905 in IL
Enrollment address
120 E Gale St
Williamsfield, IL 61489-5418
Related CCNs
140001

Other NPIs with the same Medicare PAC ID 14

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 14

Other NPIs on the same Medicare enrollment 13

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 13

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2196077Graham Medical Group120 E Gale, Williamsfield, IL 61489Certificate of waiverOct 13, 2026

National Provider Directory

National Provider Directory
Tax ID family
Graham Hospital Assoc22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

Organizations that report the same tax identification number in the National Provider Directory.

View all 21

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Allison Sours Individual Corporate OfficerPresident and Ceo Jan 6, 2026
W-2 Managing EmployeePresident & Ceo Jan 5, 2026
Operational/Managerial ControlPresident & Ceo Jan 5, 2026
Morris D Lee Individual Corporate DirectorBoard Member Jan 1, 2022
William Carlberg Individual Corporate DirectorBoard Member Jan 1, 2020
Kenneth Krock Individual Corporate DirectorBoard Member Jan 1, 2021
Terry Moss Individual Corporate DirectorBoard Member Jan 1, 2021
Janis Blout Individual Corporate DirectorBoard Member Jan 1, 2019
Erin Elizabeth Bailey Individual Corporate DirectorBoard Member Jul 1, 2025
Kevin Meade Individual Corporate DirectorBoard Member Jan 1, 2020
Patrick B Renick Individual Corporate DirectorBoard Member Jan 1, 2019
Sarah Keefer Individual Corporate DirectorBoard Member Jul 1, 2025
Julie Reeder Individual Corporate OfficerCfo Mar 6, 2017
W-2 Managing EmployeeCfo Mar 6, 2017

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1601596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680480000000",
    "number": "1508463563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 S MAIN ST",
            "city": "CANTON",
            "state": "IL",
            "postal_code": "615202608",
            "telephone_number": "309-647-0201",
            "fax_number": "309-647-8613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 E GALE ST",
            "city": "WILLIAMSFIELD",
            "state": "IL",
            "postal_code": "614895418",
            "telephone_number": "309-639-4004",
            "fax_number": "309-639-4065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAHAM HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-02",
        "last_updated": "2023-04-03",
        "certification_date": "2023-04-03",
        "status": "A",
        "authorized_official_last_name": "POSTIN",
        "authorized_official_first_name": "JANELLE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "309-647-5240"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Graham Medical Group Williamsfield",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Graham Medical Group Williamsfield",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Williamsfield, IL

Sources for this page

Verify at the official NPI Registry.