NPIMap

Good Samaritan Regional Health Center

Organization Active NPI General Acute Care Hospital · Mount Vernon, IL

NPI 1609897339 · NPPES record last updated Nov 27, 2023

Key facts

NPI
1609897339
Entity type
Organization (NPI type 2)
Primary specialty
General Acute Care Hospital 282N00000X
License
0004705 (IL)
Legal business name
GOOD SAMARITAN REGIONAL HEALTH CENTER
Practice address
1 Good Samaritan Way
Mount Vernon, IL 62864-2402
Phone
(618) 899-4600
NPI assigned
Jul 21, 2006
Organization subpart
No

Authorized official

Name
Mr. Jeremy Bradford
Title
President
Phone
(618) 899-1001

Owners & managing parties with NPI records 17

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

Other NPIs on the same Medicare enrollment 4

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

Other NPIs with the same Medicare PAC ID 3

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

Corporate family (same tax ID) 8

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Member organizations 3

Organizations listed as members of this organization in the National Provider Directory.

Facilities connected through Provider of Services related, parent or unit certification numbers.

Facilities with the same owner 30

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 30

Practitioners 155

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 155

Affiliated clinicians 451

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 451

Medicare Care Compare: Hospital

Listed as
Good Samaritan Regional HLTH Center CCN 140046
Overall star rating
★★★★☆ 4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in IL

Hospital certification: CCN 140046

Legal name
GOOD SAMARITAN REGIONAL HEALTH CENTER
Doing business as
SSM HEALTH GOOD SAMARITAN HOSPITAL - MT. VERNON
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jan 27, 2022
Beds
175
Ownership / control type
Private (not for profit)
Organization structure
Corporation · Non-profit
Incorporated
Jun 30, 1958 in IL
Enrollment address
1 Good Samaritan Way
Mount Vernon, IL 62864-2402
Main/Primary Hospital Location
Hospital subgroups
General

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Jeremy Midura
Individual 		Corporate Director
Board Member		 Dec 31, 2022
Susan Niepoetter
Individual 		Corporate Director
Board Member		 Sep 14, 2024
Temple Jackson
Individual 		W-2 Managing Employee Aug 2, 2021
Paula Friedman
Individual 		Corporate Director
Board Member		 Dec 31, 2022
Damon R Harbison
Individual 		Corporate Officer
President, Ex-Officio		 Jun 1, 2018
Eric Ibendahl
Individual 		Corporate Director
Board Member		 Dec 31, 2020
Suzie Schmidt
Individual 		Corporate Director
Board Member		 Dec 31, 2021
Rajendra Shroff
Individual 		Corporate Director
Board Member		 Mar 16, 2023
Joseph Minerath
Individual 		W-2 Managing Employee
System Director of Reimbursement		 Jul 1, 2025
Jeremy M Fotheringham
Individual 		Corporate Director
Board President		 Dec 31, 2022
SSM Health Care Corporation
Organization · Saint Louis, MO
Non-profit 		5% Or Greater Indirect Ownership Interest Sep 1, 2015 100%
Monica Heinzman
Individual 		Corporate Director
Board Member		 Sep 14, 2023
Matthew Flanigan
Individual 		Corporate Officer
Board Member		 Dec 31, 2020
Sudeep Nair
Individual 		Corporate Director
Board Member		 Dec 31, 2020
Timothy Buller
Individual 		Corporate Officer
Regional Cfo Fin Strategy		 Oct 1, 2015
SSM Regional Health Services
Organization · Saint Louis, MO
Non-profit 		5% Or Greater Direct Ownership Interest Sep 1, 2015 100%
Tena Hoyt
Individual 		Corporate Officer
Board Member		 Dec 31, 2021
Jean-Benoit Houle
Individual 		Corporate Director
Board Member		 Dec 31, 2022
Patricia Williams
Individual 		Corporate Director
Board Member		 Nov 1, 2015

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040119000325 IL Part B Supplier - Clinic/Group Practice 1658272059 Receives reassigned benefits from 280 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Salem, IL; Mount Vernon, IL; Benton, IL
O20060320000309 IL Part a Provider - Hospital 1658272059 Practice locations: Mount Vernon, IL; Centralia, IL

National Provider Directory

Tax ID family
Good Samaritan Regional Health Center (9 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X 0004705 IL
General Acute Care Hospital 282N00000X 0004705 IL Yes

Addresses

Primary practice location

1 Good Samaritan Way
Mount Vernon, IL 62864-2402

Mailing address

PO Box 503927
Saint Louis, MO 63150-0001
Phone (618) 899-4600

Other identifiers

IdentifierTypeStateIssuer
140112100OtherILACS OWCP NUMBER
33898OtherILGROUP HEALTH PLAN NUMBER
39584100OtherILBLACK LUNG NUMBER
103233OtherILHEALTHLINK NUMBER
003891OtherILHEALTH ALLIANCE NUMBER
0014OtherILBLUE CROSS/BLUE SHIELD

Other names

  • SSM Health Good Samaritan Hospital - Mt. Vernon Doing business as

Electronic endpoints

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other

Other providers in Mount Vernon, IL

All providers in Mount Vernon, IL · General Acute Care Hospital in Illinois

Sources for this page

Verify at the official NPI Registry.