NPIMap

Pana Community Hospital Association

Organization Active NPI Rural Health Clinic/Center · Cowden, IL

NPI 1720710437 · NPPES record last updated Jun 1, 2024

Key facts

NPI
1720710437
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
PANA COMMUNITY HOSPITAL ASSOCIATION
Practice address
209 E Elm St
Cowden, IL 62422-1041
Phone
(217) 783-6565
Fax
(217) 783-6577
NPI assigned
Jun 30, 2022
Organization subpart
No

Authorized official

Name
Mr. James Eugene Moon
Title
Cfo
Phone
(217) 562-2131

Owners & managing parties with NPI records 10

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

Owned or controlled facilities with NPI records 2

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

Other NPIs with the same Medicare PAC ID 9

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

Corporate family (same tax ID) 16

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.

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Facilities with the same owner 2

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

Practitioners 55

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

View all 55

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D1062059Cowden Medical Group
209 E Elm St, Cowden, IL 62422		Certificate of waiverAug 8, 2026

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IL

Rural health clinic certification: CCN 148637

Legal name
PANA COMMUNITY HOSPITAL ASSOCIATION
Doing business as
COWDEN MEDICAL GROUP
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 1, 2022
Last certification
May 14, 2026
Ownership / control type
1B
Organization structure
Corporation · Non-profit
Incorporated
Feb 8, 1966 in IL
Enrollment address
209 E Elm St
Cowden, IL 62422-1041
Related CCNs
141341

All disclosed owners & managing parties 13

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

NameRoleSinceShare
David Slater
Individual 		Corporate Director
Board Director		 May 1, 2017
James E Moon
Individual 		W-2 Managing Employee
Cfo		 Jul 6, 2010
Charles O'Malley
Individual 		Corporate Officer
Board Officer		 May 1, 2016
Frank McChristy
Individual 		Corporate Director
Board Director		 May 1, 2022
Pana Community Hospital Association
Organization · Pana, IL
Corporation, Non-profit 		5% Or Greater Direct Ownership Interest Aug 1, 2022 100%
Operational/Managerial Control Aug 1, 2022 100%
Jason Bauer
Individual 		Corporate Director
Board Director		 May 1, 2022
Kenneth Flesch
Individual 		Corporate Director
Board Director		 May 1, 2017
David Dorn
Individual 		Corporate Officer
Board Officer		 May 1, 2019
Jimmie Brewer
Individual 		Corporate Officer
Board Officer		 May 1, 2016
Katrina J Casner
Individual 		Corporate Officer
President & Ceo		 Jan 3, 2021
W-2 Managing Employee
President & Ceo		 Jan 1, 2008
Roy Goff
Individual 		Corporate Director
Board Director		 May 1, 2021
Gregory Holthaus
Individual 		Corporate Director
Board Director		 May 1, 2015
Walter H Cunnington
Individual 		Corporate Director
Board Director		 May 1, 2015

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Community Medical Clinic of Nokomis
Nokomis, IL · CCN 148574		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Dec 1, 2016
Jul 19, 2022
Community Medical Clinic of Assumption
Assumption, IL · CCN 148575		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Dec 1, 2016
Jul 19, 2022

Change-of-ownership history

DateEventCounterparty
Aug 1, 2022 Change of Ownership
This provider was the buyer		 Cowden Medical Clinic LLC
CCN 148993 · NJ · NPI 1356410781

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20220812001818 IL Part a Provider - Rural Health Clinic 3274437348 Practice locations: Cowden, IL

National Provider Directory

Tax ID family
Pana Internal Medicine (17 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 207Q00000X
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

209 E Elm St
Cowden, IL 62422-1041

Mailing address

101 E 9TH St
Pana, IL 62557-1785
Phone (217) 562-2131

Other names

  • Cowden Medical Group Doing business as

Other providers in Cowden, IL

All providers in Cowden, IL · Rural Health Clinic/Center in Illinois

Sources for this page

Verify at the official NPI Registry.