NPIMap

Organization Active NPI

Memorial Hospital Association

Doing business as Memorial Medical Clinic Broadway

  • Rural Health Clinic/Center
  • Hamilton, IL
National Provider Identifier
1679327779
Registry record updated Apr 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MEMORIAL HOSPITAL ASSOCIATION
Doing business as
Memorial Medical Clinic Broadway
Practice address
951 Broadway St
Hamilton, IL 62341-1436
Phone
(217) 551-3100
Fax
(217) 551-3024
NPI assigned
Apr 15, 2024
Last updated
Apr 15, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MEMORIAL HOSPITAL ASSOCIATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 15, 2024

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

Authorized official

Name
Teresa Smith
Title
Cfo
Phone
(217) 357-8500

Specialties & licenses 1

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

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 1

  • MEMORIAL MEDICAL CLINIC BROADWAY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240531002359 IL Part A Provider - Rural Health Clinic 0244134682 Practice locations: Hamilton, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679327779. Details of each certification follow.

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
CorporationNon-profit
Incorporated
May 26, 1947 in IL
Enrollment address
951 Broadway St
Hamilton, IL 62341-1436
Related CCNs
141305

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

Other NPIs with the same Medicare PAC ID 8

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

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
14D2305407Memorial Medical Clinic - Broadway951 Broadway St, Hamilton, IL 62341Certificate of waiverMay 29, 2028

National Provider Directory

National Provider Directory
Tax ID family
Memorial Hosptl Association9 organizations share this tax ID, including this one
Part of
Memorial Hosptl Association

Other organizations with this tax ID 8

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

Locations

213 S Adams St
Carthage, IL 62321
Phone (217) 357-0617

403 S Adams St
Ste 239
Carthage, IL 62321
Phone (217) 357-0617

951 Broadway St
Hamilton, IL 62341
Phone (217) 551-3100

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Luann S Haas Individual Corporate Director Sep 1, 1998
Teresa L Smith Individual Corporate Officer Dec 12, 2005
W-2 Managing Employee Nov 1, 2006
Karen Araya Individual Corporate Director Apr 1, 2026
Matthew Dickinson Individual Corporate Director Oct 22, 2025
Ada M Bair Individual Corporate OfficerCeo Mar 24, 2003
Patricia Schou Individual Corporate Director Jan 1, 2026
Douglas D Groth Individual Corporate Director Mar 1, 2017
Brenda Young Individual Corporate Director Sep 30, 2019
Stuart Froman Individual Corporate Director Jan 1, 2026
Matthew Kraus Individual Corporate Director Jan 1, 2026
Jami Hocker Individual Corporate Director Mar 27, 2024
Victora L Kalivoda-Popela Individual Corporate Director Sep 30, 2022
Terry a Pope Individual Corporate Director Sep 1, 2006
Jennifer Roberts Individual Corporate Director Jan 1, 2026
Dan E Asbury Individual Corporate Director Sep 1, 2002

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 95

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 95

NPI Registry JSON

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

{
    "created_epoch": "1713139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713139200000",
    "number": "1679327779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 160",
            "city": "CARTHAGE",
            "state": "IL",
            "postal_code": "623210160",
            "telephone_number": "217-357-8500",
            "fax_number": "217-357-6564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "951 BROADWAY ST",
            "city": "HAMILTON",
            "state": "IL",
            "postal_code": "623411436",
            "telephone_number": "217-551-3100",
            "fax_number": "217-551-3024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HOSPITAL ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEMORIAL HOSPITAL ASSOCIATION",
        "enumeration_date": "2024-04-15",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "217-357-8500"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MEMORIAL MEDICAL CLINIC BROADWAY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hamilton, IL

Sources for this page

Verify at the official NPI Registry.