NPIMap

Organization Active NPI

Osf Healthcare System

Doing business as OSF Holy Family Medical Center

  • Rural Health Clinic/Center
  • Roseville, IL
National Provider Identifier
1730788902
Registry record updated Mar 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
OSF HEALTHCARE SYSTEM
Doing business as
OSF Holy Family Medical Center
Practice address
235 E Penn Ave
Roseville, IL 61473-5006
Phone
(309) 426-2128
Fax
(309) 426-2455
NPI assigned
Oct 20, 2020
Last updated
Mar 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2024

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

Authorized official

Name
Robert C Sehring
Title
Chief Executive Officer
Phone
(309) 655-2850

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

235 E Penn Ave
Roseville, IL 61473-5006

Mailing address

124 SW Adams St
Peoria, IL 61602-1308
Phone (309) 655-2850

Other names 2

  • OSF Holy Family Medical Center Doing business as
  • OSF Medical Group Family Medicine Roseville Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070503000249 IL Part B Supplier - Clinic/Group Practice 4284541806 Receives reassigned benefits from 99 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Monmouth, IL; Roseville, IL; Princeton, IL; Henry, IL
O20201109003031 IL Part A Provider - Rural Health Clinic 4284541806 Practice locations: Roseville, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730788902. Details of each certification follow.

Rural health clinic certification: CCN 148621

Legal name
OSF HEALTHCARE SYSTEM
Doing business as
OSF HEALTHCARE – MEDICAL GROUP – ROSEVILLE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 18, 2021
Last certification
Feb 18, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jan 2, 1880 in IL
Enrollment address
235 E Penn Ave
Roseville, IL 61473-5006
Related CCNs
141318

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

Other NPIs on the same Medicare enrollment 5

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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0858269Osf Healthcare - Medical Group - Roseville235 E Penn, Roseville, IL 61473Certificate of waiverJan 17, 2028

National Provider Directory

National Provider Directory
Tax ID family
Osf Healthcare System50 organizations share this tax ID, including this one

Other organizations with this tax ID 49

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

View all 49

Locations

800 NE Glen Oak Ave
Peoria, IL 61603
Phone (309) 308-0448

235 E Penn Ave
Roseville, IL 61473
Phone (309) 426-2128

Ownership & related parties

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
Patricia a Brazeau Individual Corporate Director Nov 1, 2006
Anne M Ziegler Individual Corporate Director Jan 1, 2021
Melanie R Mann Individual Corporate Officer Oct 6, 2024
Corporate Director Oct 1, 2006
August Querciagrossa Individual W-2 Managing EmployeeCeo Western Region Aug 29, 2022
Operational/Managerial Control Aug 29, 2022
Gerald J McShane Individual Corporate Director Sep 1, 1996
Osf Healthcare Ministries Organization, Peoria, IL Corporation, Non-profit Operational/Managerial Control Nov 1, 2024
Kathleen F Williams Individual Corporate Director Jan 1, 2003
Kirsten M Largent Individual Corporate Officer Nov 8, 2024
W-2 Managing EmployeeChief Financial Officer Nov 8, 2024
Operational/Managerial Control Nov 8, 2024
Michelle D Conger Individual Corporate Officer Apr 3, 2026
Corporate Director Apr 3, 2026
W-2 Managing EmployeeChief Executive Apr 3, 2026
Operational/Managerial ControlChief Executive Apr 3, 2026
Judith a Duvall Individual Corporate Director Oct 1, 1989
Brian J Silverstein Individual Corporate Director Oct 1, 2015
Paula K Selamat Individual Corporate Director Oct 6, 2024
Bridget J Meidl Individual Corporate Officer Apr 3, 2026
Corporate Director Nov 1, 2014
W-2 Managing EmployeePresident Apr 3, 2026
Operational/Managerial Control Apr 3, 2026

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 46

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

FacilityTypeRoleSince
Osf Saint Anthony Medical CenterRockford, IL, CCN 140233 Hospital Operational/Managerial Control Sep 1, 2007
Osf Saint Francis Medical CenterPeoria, IL, CCN 149807 Hospital Operational/Managerial Control Jul 1, 1966
Osf Saint Paul Medical CenterMendota, IL, CCN 141310 Hospital Operational/Managerial Control Apr 1, 2015
Osf Saint Paul Medical CenterMendota, IL, CCN 14Z310 Hospital Operational/Managerial Control Apr 1, 2015
Osf Saint Elizabeth Medical CenterPeru, IL, CCN 140110 Hospital Operational/Managerial Control (100%) Apr 30, 2012
St Joseph Medical CenterBloomington, IL, CCN 140162 Hospital Operational/Managerial Control Jun 1, 1969
Osf Saint James-John W Albrecht Medical CenterPontiac, IL, CCN 140161 Hospital Operational/Managerial Control Jul 1, 1966
Osf Saint James-John W Albrecht Medical CenterPontiac, IL, CCN 14U161 Hospital Operational/Managerial Control May 4, 2010
Osf Saint Mary Medical CenterGalesburg, IL, CCN 140064 Hospital Operational/Managerial Control Jul 1, 1966
Osf Healthcare Divine Mercy Continuing Care HospitalPeoria, IL, CCN 142013 Hospital Operational/Managerial Control Oct 1, 2023
Osf Healthcare St. Francis Hospital & Medical GroupEscanaba, MI, CCN 231337 Hospital Operational/Managerial Control Jul 25, 2012
Osf Healthcare St. Francis Hospital & Medical GroupEscanaba, MI, CCN 23Z337 Hospital Operational/Managerial Control Jul 25, 2012
Osf Healthcare Divine Mercy Continuing Care HospitalPeoria, IL, CCN 14TA13 Hospital Operational/Managerial Control Oct 1, 2023
Osf Healthcare Home CareLoves Park, IL, CCN 147271 Home health agency Operational/Managerial Control Sep 10, 2010
Saint Francis Medical Center Home HealthPeoria, IL, CCN 147243 Home health agency Operational/Managerial Control Aug 26, 2010
Osf St Francis Hospital Home Health CareEscanaba, MI, CCN 237239 Home health agency Operational/Managerial Control Jun 1, 1968
St Francis HospitalGladstone, MI, CCN 238589 Rural health clinic Operational/Managerial Control Nov 3, 1983
Osf Healthcare - Medical Group - EscanabaEscanaba, MI, CCN 238590 Rural health clinic Operational/Managerial Control Sep 1, 2007
St Francis HospitalPowers, MI, CCN 238616 Rural health clinic Operational/Managerial Control Sep 1, 2007
Osf Healthcare - Medical Group - MendotaMendota, IL, CCN 148535 Rural health clinic Operational/Managerial Control Apr 1, 2015
Osf Healthcare - Medical Group - GodfreyGodfrey, IL, CCN 148612 Rural health clinic Operational/Managerial Control Sep 27, 2019
Osf Healthcare - Medical Group - StreatorStreator, IL, CCN 148624 Rural health clinic Operational/Managerial Control Apr 5, 2021
Osf Healthcare - Medical Group - PontiacPontiac, IL, CCN 148654 Rural health clinic Operational/Managerial Control Jan 1, 1966
Osf Healthcare - Medical Group - ReynoldsPontiac, IL, CCN 148650 Rural health clinic Operational/Managerial Control Jan 1, 1966
Osf Healthcare - Medical Group - DwightDwight, IL, CCN 148641 Rural health clinic Operational/Managerial Control Jan 1, 1966
Osf Healthcare - Medical Group - El PasoEl Paso, IL, CCN 148642 Rural health clinic Operational/Managerial Control Jan 1, 1966
Osf Healthcare - Medical Group - FlanaganFlanagan, IL, CCN 148644 Rural health clinic Operational/Managerial Control Jan 1, 1966
Osf Healthcare - Medical Group - GalesburgGalesburg, IL, CCN 148645 Rural health clinic Operational/Managerial Control Jan 1, 1966
Osf Healthcare - Medical Group - AbingdonAbingdon, IL, CCN 148638 Rural health clinic Operational/Managerial Control Jan 1, 1966
Osf Healthcare - Medical Group - KnoxvilleKnoxville, IL, CCN 148648 Rural health clinic Operational/Managerial Control Jan 1, 1966
Osf Promptcare - GalesburgGalesburg, IL, CCN 148646 Rural health clinic Operational/Managerial Control Jan 1, 1966
Osf Healthcare - Medical Group - SeminaryGalesburg, IL, CCN 148651 Rural health clinic Operational/Managerial Control Jan 1, 1966
Osf Healthcare - Medical Group - FairburyFairbury, IL, CCN 148643 Rural health clinic Operational/Managerial Control Jan 1, 1966
Osf Healthcare - Medical Group - MarseillesMarseilles, IL, CCN 148649 Rural health clinic Operational/Managerial Control Jan 1, 1966
Osf Healthcare - Medical Group - Ottawa SouthOttawa, IL, CCN 148652 Rural health clinic Operational/Managerial Control Apr 30, 2012
Osf Healthcare - Medical Group - OttawaOttawa, IL, CCN 148655 Rural health clinic Operational/Managerial Control Apr 30, 2012
Osf Healthcare - Medical Group - MinonkMinonk, IL, CCN 148653 Rural health clinic Operational/Managerial Control Jan 1, 1966
Osf Healthcare - Medical Group - CullomCullom, IL, CCN 148640 Rural health clinic Operational/Managerial Control Jan 1, 1966
Osf Healthcare - Medical Group - ClintonClinton, IL, CCN 148639 Rural health clinic Operational/Managerial Control Jan 1, 1966
Osf Healthcare - Medical Group - RoanokeRoanoke, IL, CCN 148658 Rural health clinic Operational/Managerial Control Jan 1, 1966
Osf Healthcare - Medical Group - Rock CutLoves Park, IL, CCN 148663 Rural health clinic Operational/Managerial Control Sep 1, 2007
Osf Healthcare - Medical Group - MidtownPeru, IL, CCN 148670 Rural health clinic Operational/Managerial Control Apr 1, 2015
Osf Healthcare - Medical Group - Spring ValleySpring Valley, IL, CCN 148668 Rural health clinic Operational/Managerial Control Apr 1, 2015
Osf Healthcare - Medical Group - OglesbyOglesby, IL, CCN 148667 Rural health clinic Operational/Managerial Control Apr 1, 2015
Osf Healthcare - Medical Group - PlazaPeru, IL, CCN 148665 Rural health clinic Operational/Managerial Control Apr 1, 2015
Osf Healthcare - Medical Group - GranvilleGranville, IL, CCN 148671 Rural health clinic Operational/Managerial Control Apr 1, 2015

Facilities with the same owner 76

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

View all 76

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1603152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710720000000",
    "number": "1730788902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 SW ADAMS ST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616021308",
            "telephone_number": "309-655-2850",
            "fax_number": "309-655-4878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 E PENN AVE",
            "city": "ROSEVILLE",
            "state": "IL",
            "postal_code": "614735006",
            "telephone_number": "309-426-2128",
            "fax_number": "309-426-2455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OSF HEALTHCARE SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-20",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A",
        "authorized_official_last_name": "SEHRING",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "309-655-2850"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OSF Holy Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "OSF Medical Group Family Medicine Roseville",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "OSF Medical Group Family Medicine Roseville",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Roseville, IL

Sources for this page

Verify at the official NPI Registry.