NPIMap

Organization Active NPI

Mason Hospital District

Doing business as Mason District Hospital

  • Ambulance
  • Havana, IL
National Provider Identifier
1689823866
Registry record updated Sep 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
AmbulanceTaxonomy code 341600000X
Legal business name
MASON HOSPITAL DISTRICT
Doing business as
Mason District Hospital
Practice address
615 N Promenade St
Havana, IL 62644-1243
Phone
(309) 543-4431
Fax
(309) 543-8528
NPI assigned
Sep 12, 2008
Last updated
Sep 12, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2008

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

Authorized official

Name
Mr. Robert J Stolba
Title
Cfo
Phone
(309) 543-8505

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulance 341600000X IL Primary

Addresses

Primary practice location

615 N Promenade St
Havana, IL 62644-1243

Mailing address

615 N Promenade St
PO Box 530
Havana, IL 62644-1243
Phone (309) 543-4431

Other names 1

  • Mason District Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030311000010 IL Part A Provider - Critical Access Hospital 2466360607 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Havana, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689823866. Details of each certification follow.

Hospital certification: CCN 141313

Legal name
MASON HOSPITAL DISTRICT
Doing business as
MASON DISTRICT HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jul 1, 2001
Last certification
May 20, 2015
Beds
25
Ownership / control type
Hospital district or authority
Organization structure
GovernmentNon-profit
Enrollment address
615 N Promenade St
Havana, IL 62644-1243
Main/Primary Hospital Location

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Mason District HospitalCCN 141313 · All quality measures
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Mason Dist Hosp Ekg9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Mason Hospital District Organization, Havana, IL 5% Or Greater Direct Ownership Interest Apr 23, 2014 100%
Leann K Bonnett Individual Corporate DirectorCfo Sep 3, 2015
W-2 Managing Employee Sep 3, 2015
Operational/Managerial Control Sep 3, 2015
Douglas Kosier Individual Corporate OfficerCeo Jun 27, 2000
W-2 Managing Employee Jun 27, 2000
Operational/Managerial Control Jun 27, 2000

Owners & managing parties with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 61

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

View all 61

NPI Registry JSON

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

{
    "created_epoch": "1221177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221177600000",
    "number": "1689823866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 N PROMENADE ST",
            "address_2": "PO BOX 530",
            "city": "HAVANA",
            "state": "IL",
            "postal_code": "626441243",
            "telephone_number": "309-543-4431",
            "fax_number": "309-543-8528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 N PROMENADE ST",
            "city": "HAVANA",
            "state": "IL",
            "postal_code": "626441243",
            "telephone_number": "309-543-4431",
            "fax_number": "309-543-8528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASON HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-12",
        "last_updated": "2008-09-12",
        "status": "A",
        "authorized_official_last_name": "STOLBA",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "309-543-8505",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mason District Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Havana, IL

Sources for this page

Verify at the official NPI Registry.