Memorial Hospital Association
Organization Active NPI Rural Health Clinic/Center · Hamilton, IL
NPI 1679327779 · NPPES record last updated Apr 15, 2024
Key facts
- NPI
- 1679327779
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- MEMORIAL HOSPITAL ASSOCIATION
- Practice address
- 951 Broadway St
Hamilton, IL 62341-1436 - Phone
- (217) 551-3100
- Fax
- (217) 551-3024
- NPI assigned
- Apr 15, 2024
- Organization subpart
- Yes
- Parent organization (as reported)
- MEMORIAL HOSPITAL ASSOCIATION
Authorized official
- Name
- Teresa Smith
- Title
- Cfo
- Phone
- (217) 357-8500
Owners & managing parties with NPI records 1
Other NPIs with the same Medicare PAC ID 8
Corporate family (same tax ID) 8
Related certifications (CCN) 1
Practitioners 99
-
Tracey Lynn-Severt Behymer, FNP-BC
-
Melissa K Brewer, FNP-BC
-
George Brummell, PMHNP-BC
-
Lindsay Brummell, LPC
-
Joshua James Byrd, DOCTOR
-
Rosalinda Campos, M.D
-
Monica Gail Crim, APN
-
Casey Dooley, PA-C
-
Lila Brooks Fritz, RN, C-NM
-
Janette Andrea Glass, N.P.
-
Douglas Alan Heighton, M.D.
-
Christopher Martin Jones, M.D.
-
Jeffrey A Leon, PA C
-
Edward F McKenney, D.O.
-
Gavin O'Neil, LISW, LCSW
-
Michael D Ottney, D.O.
-
Elizabeth A Pickering, PA-C
-
Daniel E Schneider, M.D.
-
Richard Paul Sowlles, DPM
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D2305407 | Memorial Medical Clinic - Broadway | Certificate of waiver | May 29, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Rural health clinic certification: CCN 148676
- Legal name
- MEMORIAL HOSPITAL ASSOCIATION
- Doing business as
- MEMORIAL MEDICAL CLINIC BROADWAY
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Nov 21, 2025
- Last certification
- Nov 21, 2025
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 26, 1947 in IL
- Enrollment address
- 951 Broadway St
Hamilton, IL 62341-1436 - Related CCNs
- 141305
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Luann S Haas |
Corporate Director | Sep 1, 1998 | |
| Teresa L Smith |
Corporate Officer | Dec 12, 2005 | |
| W-2 Managing Employee | Nov 1, 2006 | ||
| Karen Araya |
Corporate Director | Apr 1, 2026 | |
| Matthew Dickinson |
Corporate Director | Oct 22, 2025 | |
| Ada M Bair |
Corporate Officer |
Mar 24, 2003 | |
| Patricia Schou |
Corporate Director | Jan 1, 2026 | |
| Douglas D Groth |
Corporate Director | Mar 1, 2017 | |
| Brenda Young |
Corporate Director | Sep 30, 2019 | |
| Stuart Froman |
Corporate Director | Jan 1, 2026 | |
| Matthew Kraus |
Corporate Director | Jan 1, 2026 | |
| Jami Hocker |
Corporate Director | Mar 27, 2024 | |
| Victora L Kalivoda-Popela |
Corporate Director | Sep 30, 2022 | |
| Terry a Pope |
Corporate Director | Sep 1, 2006 | |
| Jennifer Roberts |
Corporate Director | Jan 1, 2026 | |
| Dan E Asbury |
Corporate Director | Sep 1, 2002 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240531002359 | IL | Part a Provider - Rural Health Clinic | 0244134682 | Practice locations: Hamilton, IL |
National Provider Directory
- Tax ID family
- Memorial Hospital Association
- Part of
- Memorial Hospital Association
Locations
213 S Adams St
Carthage, IL 62321
Phone (217) 357-0617
501 E Main St
La Harpe, IL 61450
Phone (217) 659-3844
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
951 Broadway St
Hamilton, IL 62341-1436
Mailing address
PO Box 160
Carthage, IL 62321-0160
Phone (217) 357-8500
Other names
- MEMORIAL MEDICAL CLINIC BROADWAY
Other providers in Hamilton, IL
- Mary Angela Glasgow
- Hamilton CCSD 328
- Hy-Vee Inc
- May Rose Delluza Marquez
- Edward F McKenney
- Benjamin Philip Morgan
- Susan Elaine Peters
- Daniel Reinhardt
- Max Rodeffer
- Zachary Alan Rodeffer
All providers in Hamilton, IL · Rural Health Clinic/Center in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 15, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.