Osf Healthcare System
Organization Active NPI Rural Health Clinic/Center · Roseville, IL
NPI 1730788902 · NPPES record last updated Mar 18, 2024
Key facts
- NPI
- 1730788902
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- OSF HEALTHCARE SYSTEM
- Practice address
- 235 E Penn Ave
Roseville, IL 61473-5006 - Phone
- (309) 426-2128
- Fax
- (309) 426-2455
- NPI assigned
- Oct 20, 2020
- Organization subpart
- No
Authorized official
- Name
- Robert C Sehring
- Title
- Chief Executive Officer
- Phone
- (309) 655-2850
Owners & managing parties with NPI records 1
Other NPIs on the same Medicare enrollment 5
Corporate family (same tax ID) 49
Related certifications (CCN) 1
Facilities with the same owner 76
Practitioners 13
-
Astrid Bianca Herard, M.D.
-
Kellie Marie Kozlowski, PMHNP-BC
-
Kevin J Kusler, PA-C
-
Veronica Spangler, FNP-C
-
Rahul Ramesh Sampat, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D0858269 | Osf Healthcare - Medical Group - Roseville | Certificate of waiver | Jan 17, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL
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
- Corporation · Non-profit
- Incorporated
- Jan 2, 1880 in IL
- Enrollment address
- 235 E Penn Ave
Roseville, IL 61473-5006 - Related CCNs
- 141318
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Patricia a Brazeau |
Corporate Director | Nov 1, 2006 | |
| Anne M Ziegler |
Corporate Director | Jan 1, 2021 | |
| Melanie R Mann |
Corporate Officer | Oct 6, 2024 | |
| Corporate Director | Oct 1, 2006 | ||
| August Querciagrossa |
W-2 Managing Employee |
Aug 29, 2022 | |
| Operational/Managerial Control | Aug 29, 2022 | ||
| Gerald J McShane |
Corporate Director | Sep 1, 1996 | |
| Osf Healthcare Ministries |
Operational/Managerial Control | Nov 1, 2024 | |
| Kathleen F Williams |
Corporate Director | Jan 1, 2003 | |
| Kirsten M Largent |
Corporate Officer | Nov 8, 2024 | |
| W-2 Managing Employee |
Nov 8, 2024 | ||
| Operational/Managerial Control | Nov 8, 2024 | ||
| Michelle D Conger |
Corporate Officer | Apr 3, 2026 | |
| Corporate Director | Apr 3, 2026 | ||
| W-2 Managing Employee |
Apr 3, 2026 | ||
| Operational/Managerial Control |
Apr 3, 2026 | ||
| Judith a Duvall |
Corporate Director | Oct 1, 1989 | |
| Brian J Silverstein |
Corporate Director | Oct 1, 2015 | |
| Paula K Selamat |
Corporate Director | Oct 6, 2024 | |
| Bridget J Meidl |
Corporate Officer | Apr 3, 2026 | |
| Corporate Director | Nov 1, 2014 | ||
| W-2 Managing Employee |
Apr 3, 2026 | ||
| Operational/Managerial Control | Apr 3, 2026 |
All facility ownership & control disclosures 46
| Facility | Type | Role | Since |
|---|---|---|---|
| Osf Saint Anthony Medical Center |
Hospital | Operational/Managerial Control | Sep 1, 2007 |
| Osf Saint Francis Medical Center |
Hospital | Operational/Managerial Control | Jul 1, 1966 |
| Osf Saint Paul Medical Center |
Hospital | Operational/Managerial Control | Apr 1, 2015 |
| Osf Saint Paul Medical Center |
Hospital | Operational/Managerial Control | Apr 1, 2015 |
| Osf Saint Elizabeth Medical Center |
Hospital | Operational/Managerial Control (100%) | Apr 30, 2012 |
| St Joseph Medical Center |
Hospital | Operational/Managerial Control | Jun 1, 1969 |
| Osf Saint James-John W Albrecht Medical Center |
Hospital | Operational/Managerial Control | Jul 1, 1966 |
| Osf Saint James-John W Albrecht Medical Center |
Hospital | Operational/Managerial Control | May 4, 2010 |
| Osf Saint Mary Medical Center |
Hospital | Operational/Managerial Control | Jul 1, 1966 |
| Osf Healthcare Divine Mercy Continuing Care Hospital |
Hospital | Operational/Managerial Control | Oct 1, 2023 |
| Osf Healthcare St. Francis Hospital & Medical Group |
Hospital | Operational/Managerial Control | Jul 25, 2012 |
| Osf Healthcare St. Francis Hospital & Medical Group |
Hospital | Operational/Managerial Control | Jul 25, 2012 |
| Osf Healthcare Divine Mercy Continuing Care Hospital |
Hospital | Operational/Managerial Control | Oct 1, 2023 |
| Osf Healthcare Home Care |
Home health agency | Operational/Managerial Control | Sep 10, 2010 |
| Saint Francis Medical Center Home Health |
Home health agency | Operational/Managerial Control | Aug 26, 2010 |
| Osf St Francis Hospital Home Health Care |
Home health agency | Operational/Managerial Control | Jun 1, 1968 |
| St Francis Hospital |
Rural health clinic | Operational/Managerial Control | Nov 3, 1983 |
| Osf Healthcare - Medical Group - Escanaba |
Rural health clinic | Operational/Managerial Control | Sep 1, 2007 |
| St Francis Hospital |
Rural health clinic | Operational/Managerial Control | Sep 1, 2007 |
| Osf Healthcare - Medical Group - Mendota |
Rural health clinic | Operational/Managerial Control | Apr 1, 2015 |
| Osf Healthcare - Medical Group - Godfrey |
Rural health clinic | Operational/Managerial Control | Sep 27, 2019 |
| Osf Healthcare - Medical Group - Streator |
Rural health clinic | Operational/Managerial Control | Apr 5, 2021 |
| Osf Healthcare - Medical Group - Pontiac |
Rural health clinic | Operational/Managerial Control | Jan 1, 1966 |
| Osf Healthcare - Medical Group - Reynolds |
Rural health clinic | Operational/Managerial Control | Jan 1, 1966 |
| Osf Healthcare - Medical Group - Dwight |
Rural health clinic | Operational/Managerial Control | Jan 1, 1966 |
| Osf Healthcare - Medical Group - El Paso |
Rural health clinic | Operational/Managerial Control | Jan 1, 1966 |
| Osf Healthcare - Medical Group - Flanagan |
Rural health clinic | Operational/Managerial Control | Jan 1, 1966 |
| Osf Healthcare - Medical Group - Galesburg |
Rural health clinic | Operational/Managerial Control | Jan 1, 1966 |
| Osf Healthcare - Medical Group - Abingdon |
Rural health clinic | Operational/Managerial Control | Jan 1, 1966 |
| Osf Healthcare - Medical Group - Knoxville |
Rural health clinic | Operational/Managerial Control | Jan 1, 1966 |
| Osf Promptcare - Galesburg |
Rural health clinic | Operational/Managerial Control | Jan 1, 1966 |
| Osf Healthcare - Medical Group - Seminary |
Rural health clinic | Operational/Managerial Control | Jan 1, 1966 |
| Osf Healthcare - Medical Group - Fairbury |
Rural health clinic | Operational/Managerial Control | Jan 1, 1966 |
| Osf Healthcare - Medical Group - Marseilles |
Rural health clinic | Operational/Managerial Control | Jan 1, 1966 |
| Osf Healthcare - Medical Group - Ottawa South |
Rural health clinic | Operational/Managerial Control | Apr 30, 2012 |
| Osf Healthcare - Medical Group - Ottawa |
Rural health clinic | Operational/Managerial Control | Apr 30, 2012 |
| Osf Healthcare - Medical Group - Minonk |
Rural health clinic | Operational/Managerial Control | Jan 1, 1966 |
| Osf Healthcare - Medical Group - Cullom |
Rural health clinic | Operational/Managerial Control | Jan 1, 1966 |
| Osf Healthcare - Medical Group - Clinton |
Rural health clinic | Operational/Managerial Control | Jan 1, 1966 |
| Osf Healthcare - Medical Group - Roanoke |
Rural health clinic | Operational/Managerial Control | Jan 1, 1966 |
| Osf Healthcare - Medical Group - Rock Cut |
Rural health clinic | Operational/Managerial Control | Sep 1, 2007 |
| Osf Healthcare - Medical Group - Midtown |
Rural health clinic | Operational/Managerial Control | Apr 1, 2015 |
| Osf Healthcare - Medical Group - Spring Valley |
Rural health clinic | Operational/Managerial Control | Apr 1, 2015 |
| Osf Healthcare - Medical Group - Oglesby |
Rural health clinic | Operational/Managerial Control | Apr 1, 2015 |
| Osf Healthcare - Medical Group - Plaza |
Rural health clinic | Operational/Managerial Control | Apr 1, 2015 |
| Osf Healthcare - Medical Group - Granville |
Rural health clinic | Operational/Managerial Control | Apr 1, 2015 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Eastland Med Plaza Surg
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 999 | Medicaid | IL |
Other names
- OSF Holy Family Medical Center
- OSF Medical Group Family Medicine Roseville
Other providers in Roseville, IL
- Goldwater Care Roseville LLC
- Amy B Huston III
- Jayme Renee Johnson
- Ward Scott Jones
- Ronald Leonard
- Petersen Health Care Roseville LLC
- Roseville Area Ambulance SVC
- Brittni Zimmerman
All providers in Roseville, IL · Rural Health Clinic/Center in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 18, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.