NPIMap

Mason Hospital District

Organization Active NPI Ambulance · Havana, IL

NPI 1689823866 · NPPES record last updated Sep 12, 2008

Key facts

NPI
1689823866
Entity type
Organization (NPI type 2)
Primary specialty
Ambulance 341600000X
Legal business name
MASON HOSPITAL DISTRICT
Practice address
615 N Promenade St
Havana, IL 62644-1243
Phone
(309) 543-4431
Fax
(309) 543-8528
NPI assigned
Sep 12, 2008
Organization subpart
No

Authorized official

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

Owners & managing parties with NPI records 5

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

Other NPIs on the same Medicare enrollment 1

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

Corporate family (same tax ID) 7

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.

Practitioners 1

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

Affiliated clinicians 61

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

View all 61

Medicare Care Compare: Hospital

Listed as
Mason District Hospital CCN 141313
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IL

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
Government · Non-profit
Enrollment address
615 N Promenade St
Havana, IL 62644-1243
Main/Primary Hospital Location

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 Director
Cfo		 Sep 3, 2015
W-2 Managing Employee Sep 3, 2015
Operational/Managerial Control Sep 3, 2015
Douglas Kosier
Individual 		Corporate Officer
Ceo		 Jun 27, 2000
W-2 Managing Employee Jun 27, 2000
Operational/Managerial Control Jun 27, 2000

Medicare enrollment records

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

National Provider Directory

Tax ID family
Asadullah Saira MD (8 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulance 341600000X IL Yes

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

  • Mason District Hospital Doing business as

Other providers in Havana, IL

All providers in Havana, IL · Ambulance in Illinois

Sources for this page

Verify at the official NPI Registry.