NPIMap

Organization Active NPI

Memorial Hospital Association

  • Critical Access Hospital
  • Carthage, IL
National Provider Identifier
1730139031
Registry record updated Apr 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
0005611 Issued in IL
Legal business name
MEMORIAL HOSPITAL ASSOCIATION
Practice address
1454 N County Road 2050
Carthage, IL 62321-3551
Phone
(217) 357-8562
Fax
(217) 357-8564
NPI assigned
May 10, 2006
Last updated
Apr 5, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2019

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

Authorized official

Name
Ada M Bair
Title
Ceo
Phone
(217) 357-8566

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 0005611 IL Primary

Addresses

Primary practice location

1454 N County Road 2050
Carthage, IL 62321-3551

Mailing address

PO Box 160
Carthage, IL 62321-0160
Phone (217) 357-8500

Other identifiers 6

IdentifierTypeStateIssuer
0901017MedicaidIA
010495307MedicaidMO
0199OtherILBLUE CROSS
113150OtherILHEALTHLINK
3415003OtherILBLUE SHIELD
L012131OtherILTRICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20031126000246 IL Part B Supplier - Clinic/Group Practice 0244134682 Receives reassigned benefits from 74 practitioners
5 other NPIs on this enrollment
Practice locations: Nauvoo, IL; Colchester, IL; Carthage, IL
O20090407000082 IL Part B Supplier - Clinic/Group Practice 0446140180 Receives reassigned benefits from 78 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Monmouth, IL; Macomb, IL; Carthage, IL
O20121211000439 IL Part A Provider - Critical Access Hospital 0244134682 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Carthage, IL
O20140626000252 IL Part A Provider - Critical Access Hospital 0244134682 Receives reassigned benefits from 51 practitioners
Practice locations: Carthage, IL

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1730139031. Details of each certification follow.

Hospital certification: CCN 14Z305

Legal name
MEMORIAL HOSPITAL ASSOCIATION
Doing business as
MEMORIAL HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
May 26, 1947 in IL
Enrollment address
1454 N County Road 2050
Carthage, IL 62321-3551
Other Hospital Practice Location

Hospital certification: CCN 141305

Legal name
MEMORIAL HOSPITAL ASSOCIATION
Doing business as
MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Aug 8, 2000
Last certification
Dec 15, 2017
Beds
48 (25 certified)
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
1454 N County Road 2050 E
Carthage, IL 62321-3551
Main/Primary Hospital Location

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).

Other NPIs on the same Medicare enrollment 12

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Memorial HospitalCCN 141305 · All quality measures
Overall star rating
4 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
McDonough Dist Hospital20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

Locations

1450 N County Road 2050 E
Carthage, IL 62321
Phone (217) 357-2173

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 DirectorHospital/Senior Services VP Apr 30, 2017
Corporate Officer Apr 26, 2017
Corporate Director Sep 1, 1998
Teresa L Smith Individual Corporate OfficerCfo Dec 12, 2005
W-2 Managing Employee Dec 12, 2005
Corporate OfficerCfo Jun 27, 2018
W-2 Managing EmployeeCfo Dec 12, 2005
Operational/Managerial ControlCfo Dec 12, 2005
Karen Araya Individual Corporate Director Oct 29, 2024
Matthew Dickinson Individual Corporate Director Apr 1, 2025
Corporate Director Oct 22, 2025
Ada M Bair Individual Corporate OfficerCeo Nov 6, 2003
Corporate OfficerCeo Jun 27, 2018
W-2 Managing EmployeeCeo Nov 6, 2005
Operational/Managerial ControlCeo Mar 24, 2003
Patricia Schou Individual Corporate Director Oct 29, 2024
Douglas D Groth Individual Corporate DirectorPresident Mar 1, 2017
Corporate DirectorPresident Sep 27, 2017
Brenda Young Individual Corporate DirectorBoard Member Sep 30, 2020
Other Sep 30, 2020
Stuart Froman Individual Corporate Director Oct 22, 2025
Matthew Kraus Individual Corporate Director Oct 22, 2025
Jami Hocker Individual Corporate Director Mar 27, 2024
Victora L Kalivoda-Popela Individual Corporate Director Sep 30, 2022
Terry a Pope Individual Corporate DirectorBoard Member Sep 1, 2013
Corporate Director Sep 1, 2006
Jennifer Roberts Individual Corporate Director Oct 22, 2025
Dan E Asbury Individual Corporate Director Sep 1, 2015
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 104

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 104

Affiliated clinicians 155

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

View all 155

NPI Registry JSON

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

{
    "created_epoch": "1147219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554422400000",
    "number": "1730139031",
    "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": "1454 N COUNTY ROAD 2050",
            "city": "CARTHAGE",
            "state": "IL",
            "postal_code": "623213551",
            "telephone_number": "217-357-8562",
            "fax_number": "217-357-8564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-10",
        "last_updated": "2019-04-05",
        "status": "A",
        "authorized_official_last_name": "BAIR",
        "authorized_official_first_name": "ADA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "217-357-8566"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IL",
            "license": "0005611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0901017",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010495307",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0199",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "113150",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "3415003",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "L012131",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Carthage, IL

Sources for this page

Verify at the official NPI Registry.