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Memorial Hospital

Organization Active NPI Rural Health Clinic/Center · Chester, IL

NPI 1629469002 · NPPES record last updated Oct 11, 2024

Key facts

NPI
1629469002
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
MEMORIAL HOSPITAL
Practice address
1900 State St
Chester, IL 62233-1116
Phone
(618) 826-2388
NPI assigned
Feb 6, 2015
Organization subpart
No

Authorized official

Name
Mrs. Morgan Bendorf
Title
Cfo
Phone
(618) 826-4581

Owners & managing parties with NPI records 3

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

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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) 4

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

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

Facilities with the same owner 1

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

Practitioners 29

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

View all 29

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IL

Rural health clinic certification: CCN 148543

Legal name
MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 1, 2015
Last certification
Mar 21, 2023
Ownership / control type
2B
Organization structure
Corporation · Proprietary
Incorporated
Mar 14, 1962 in IL
Enrollment address
1900 State St
Chester, IL 62233-1116
Related CCNs
141338

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Mary Sulser
Individual 		Corporate Director
Board Member		 Jul 6, 2015 100%
Michael Vasquez
Individual 		Corporate Director
Board Member		 Jun 1, 2015 100%
Mary Brown
Individual 		Corporate Director
Board Member		 Jul 6, 2015 100%
Grant Deterding
Individual 		Corporate Director
Board Member		 Jul 28, 2017 100%
Evelyn Schuwerk
Individual 		Corporate Director
Board Member		 Jun 1, 2015 100%
Brett a Bollmann
Individual 		Corporate Officer
Ceo		 Sep 7, 2017
W-2 Managing Employee
Ceo		 Jun 1, 2015 100%
Memorial Hospital
Organization · Chester, IL 		5% Or Greater Direct Ownership Interest Jun 1, 2015 100%
Cassandra Parker
Individual 		Corporate Director
Board Member		 Aug 1, 2022 100%
Morgan K Bendorf
Individual 		Corporate Officer
Chief Financial Officer		 Oct 1, 2017
W-2 Managing Employee
Cfo		 Oct 1, 2017 100%
Gregory Crain
Individual 		Corporate Director
Board Member		 Aug 1, 2022 100%
Thomas Search
Individual 		Corporate Director
Board Member		 Jun 1, 2015 100%
Daniel R Colvis
Individual 		Corporate Director
Board Member		 Jun 1, 2015 100%

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Memorial Hospital
Steeleville, IL · CCN 148542		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2015

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20150414000018 IL Part a Provider - Rural Health Clinic 5294649372 Practice locations: Chester, IL

National Provider Directory

Tax ID family
Memorial Hosp Holter Mo (5 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X 036-051292 IL
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X 036-052369 IL
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X 036-130378 IL
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X 036-087561 IL
Surgery Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208600000X 036-127160 IL
Surgery Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 208600000X 036-046019 IL
Rural Health Clinic/Center 261QR1300X Yes
Critical Access Hospital 282NC0060X 0001495 IL
Physician Assistant
Group: 193200000X MULTI-SPECIALTY GROUP		 363A00000X 085-003568 IL
Physician Assistant
Group: 193200000X MULTI-SPECIALTY GROUP		 363A00000X 085-003575 IL
Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP		 363L00000X 209-009681 IL
Certified Registered Nurse Anesthetist
Group: 193200000X MULTI-SPECIALTY GROUP		 367500000X 041-149926 IL
Certified Registered Nurse Anesthetist
Group: 193200000X MULTI-SPECIALTY GROUP		 367500000X 209-009387 IL

Addresses

Primary practice location

1900 State St
Chester, IL 62233-1116

Mailing address

1900 State St
Chester, IL 62233-1116
Phone (618) 826-4581

Other names

  • Randolph Hospital District Other name

Other providers in Chester, IL

All providers in Chester, IL · Rural Health Clinic/Center in Illinois

Sources for this page

Verify at the official NPI Registry.