NPIMap

Organization Active NPI

Harrisburg Medical Center Inc

Doing business as HMC Clinic at Marion

  • Rural Health Clinic/Center
  • Marion, IL
National Provider Identifier
1649795659
Registry record updated Aug 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HARRISBURG MEDICAL CENTER INC
Doing business as
HMC Clinic at Marion
Practice address
3106 Outer Dr
Marion, IL 62959-5270
Phone
(618) 997-4332
Fax
(618) 969-8628
NPI assigned
Aug 10, 2017
Last updated
Aug 13, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2025

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

Authorized official

Name
Warren P Ladner
Title
Senior VP Chief Financial Officer
Phone
(618) 457-5200

Specialties & licenses 1

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

Addresses

Primary practice location

3106 Outer Dr
Marion, IL 62959-5270

Mailing address

PO Box 3988
Carbondale, IL 62902-3988
Phone (618) 457-5200

Other names 1

  • HMC Clinic at Marion Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031113000179 IL Part B Supplier - Clinic/Group Practice 9638083884 Receives reassigned benefits from 48 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Eldorado, IL; Harrisburg, IL; Marion, IL
O20171024000135 IL Part A Provider - Rural Health Clinic 9638083884 Practice locations: Marion, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649795659. Details of each certification follow.

Rural health clinic certification: CCN 148590

Legal name
HARRISBURG MEDICAL CENTER INC
Doing business as
HARRISBURG MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 5, 2018
Last certification
Jun 5, 2018
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
3106 Outer Dr
Marion, IL 62959-5270
Related CCNs
140210

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

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 5

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

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
14D1012520HMC Clinic at Marion3106 W Outer Circle Dr, Ste 200, Marion, IL 62959ComplianceJan 13, 2028

National Provider Directory

National Provider Directory

Member of 1

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

Locations

3106 Outer Dr
Marion, IL 62959
Phone (618) 997-4332

3106 Outer Dr
#200
Marion, IL
Phone (618) 997-4332

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Krystina L Eubanks Individual Corporate DirectorBoard Member Jun 28, 2025
David Businaro Individual Corporate DirectorBoard Member Feb 1, 2018
John Millstead Individual Corporate DirectorBoard Member Aug 1, 2021
Jacqueline Scott Individual Corporate DirectorBoard Member Mar 28, 2022
Southern Illinois Healthcare Enterprises Inc Organization, Carbondale, IL Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Aug 1, 2021 100%
Southern Illinois Hospital Services Organization, Carbondale, IL Corporation, Non-profit 5% Or Greater Direct Ownership Interest Aug 1, 2021 100%
Warren P Ladner Individual Corporate Officer Feb 21, 2022
W-2 Managing Employee Feb 21, 2022
Angela Rowe Individual Corporate DirectorBoard Member Feb 26, 2019
Jonah Rice Individual Corporate DirectorVice-Chair, Executive Jun 22, 2024
Gina Sirach Individual Corporate DirectorBoard Member Jan 1, 2021
Matthew C Winkleman Individual Corporate DirectorExecutive Mar 28, 2022
Harrisburg Medical Center Inc Organization, Harrisburg, IL Corporation, Non-profit Operational/Managerial Control Dec 1, 2017 100%
Shannon S Hartke Individual W-2 Managing Employee Apr 14, 2023
John D Antes Individual Corporate Officer Dec 12, 2022
W-2 Managing Employee Jul 20, 2023

Owners & managing parties with NPI records 13

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

View all 13

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Harrisburg Medical Center IncHarrisburg, IL, CCN 140210 Hospital Operational/Managerial Control (100%) Oct 18, 1974
Harrisburg Medical CenterHarrisburg, IL, CCN 14S210 Hospital Operational/Managerial Control Oct 18, 1974
Harrisburg Medical CenterHarrisburg, IL, CCN 14U210 Hospital Operational/Managerial Control Oct 18, 1974
Eldorado Primary CareEldorado, IL, CCN 143473 Rural health clinic Operational/Managerial Control (100%) Mar 1, 2010

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 16

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

View all 16

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1502323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755043200000",
    "number": "1649795659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3988",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629023988",
            "telephone_number": "618-457-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3106 OUTER DR",
            "city": "MARION",
            "state": "IL",
            "postal_code": "629595270",
            "telephone_number": "618-997-4332",
            "fax_number": "618-969-8628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARRISBURG MEDICAL CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-10",
        "last_updated": "2025-08-13",
        "certification_date": "2025-08-13",
        "status": "A",
        "authorized_official_last_name": "LADNER",
        "authorized_official_first_name": "WARREN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "SENIOR VP CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "618-457-5200"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HMC Clinic at Marion",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HMC Clinic at Marion",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marion, IL

Sources for this page

Verify at the official NPI Registry.