Memorial Medical Center

Primary specialty

General Acute Care HospitalTaxonomy code 282N00000X

License

0004606 Issued in IL

Legal business name

MEMORIAL MEDICAL CENTER

Doing business as

Centegra Hospital Woodstock

Practice address

3701 Doty Rd
Woodstock, IL 60098-7509

Phone

(815) 338-2500

Fax

(815) 334-3948

NPI assigned

Jul 31, 2006

Last updated

Mar 21, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David Tomlinson

Title

Cio & Cfo

Phone

(815) 788-5831

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Centegra Hospital Woodstock Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730194259. Details of each certification follow.

• CCN 140176 Hospital · Terminated · Name & address match · Details

Hospital certification: CCN 140176

Legal name

CENTEGRA HEALTH SYSTEM - WOODSTOCK HOSPITAL

Certification status

Terminated Voluntary: merger or closure, Jul 1, 2018

Provider type (POS)

Hospital – Short-term

Participating since

Jul 1, 1966

Last certification

Jun 14, 2012

Beds

190

Ownership / control type

Private (not for profit)

Facility address

3701 Doty Road
Woodstock, IL 60098

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1395360000000",
    "number": "1730194259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "527 W SOUTH ST",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600983756",
            "telephone_number": "815-338-2500",
            "fax_number": "815-334-3948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 DOTY RD",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600987509",
            "telephone_number": "815-338-2500",
            "fax_number": "815-334-3948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-31",
        "last_updated": "2014-03-21",
        "status": "A",
        "authorized_official_last_name": "TOMLINSON",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CIO & CFO",
        "authorized_official_telephone_number": "815-788-5831"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "IL",
            "license": "0001503",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "IL",
            "license": "0004606",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "79",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS SUBSTANCE ABUSE",
            "identifier": "1819",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centegra Hospital Woodstock",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Norman J Mecwan, PT
• Gabrielle Melchert
• Memorial Medical Center
• Memorial Medical Center (Centegra Hospital Woodstock)
• Memorial Medical Center (Centegra Hospital Woodstock)
• Mercy Health System Corporation (Mercy Woodstock Pharmacy)
• Mercy Health System Corporation (Mercy Woodstock Medical Center)
• John G Merkling, D.C.
• Susan Merlo
• Robert L Meyer, PHD

• General Acute Care Hospital in Woodstock, IL
• Providers in Woodstock, IL by specialty
• General Acute Care Hospital in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.