NPIMap

Organization Active NPI

Massac Memorial Hospital

Doing business as Massac Memorial Medical Clinic

  • Rural Health Clinic/Center
  • Metropolis, IL
National Provider Identifier
1740355809
Registry record updated Aug 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
0001420 Issued in IL
Legal business name
MASSAC MEMORIAL HOSPITAL
Doing business as
Massac Memorial Medical Clinic
Practice address
1204 W 10TH St Ste a&B
Metropolis, IL 62960-2480
Phone
(618) 524-2176
Fax
(618) 524-4131
NPI assigned
Nov 22, 2006
Last updated
Aug 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2025

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

Authorized official

Name
Mrs. Lynn Goines
Title
Cfo
Phone
(618) 524-2176

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 0001420 IL Primary

Addresses

Primary practice location

1204 W 10TH St Ste a&B
Metropolis, IL 62960-2480

Mailing address

PO Box 790
Metropolis, IL 62960-0790
Phone (618) 524-2176

Other names 1

  • Massac Memorial Medical Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040322000487 IL Part B Supplier - Clinic/Group Practice 3072422799 Receives reassigned benefits from 18 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Metropolis, IL
O20071108000167 IL Part A Provider - Rural Health Clinic 3072422799 Practice locations: Metropolis, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740355809. Details of each certification follow.

Rural health clinic certification: CCN 143478

Legal name
MASSAC MEMORIAL HOSPITAL
Doing business as
MASSAC MEMORIAL MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 7, 2006
Last certification
May 2, 2025
Ownership / control type
Non-profit – church related
Organization structure
GovernmentNon-profit
Enrollment address
1204 W 10TH St
Ste a&B
Metropolis, IL 62960-2480
Related CCNs
141323

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

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Tax ID family
Massac Memorial Hospital4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

1204 W 10th St
Ste A
Metropolis, IL 62960
Phone (618) 524-3572

1204 W 10th St
Ste Ab
Metropolis, IL 62960
Phone (618) 524-2176

28 Chick St
Metropolis, IL 62960
Phone (618) 427-2680

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
Lynn Ann Goines Individual Corporate OfficerCfo Apr 1, 2018
Corporate DirectorCfo Apr 1, 2018
W-2 Managing EmployeeCfo Apr 1, 2018
Bharat K Patel Individual Corporate DirectorBoard Member Jan 1, 2024
Maxine Russell Individual Corporate OfficerBoard Member Jan 1, 2025
Hailey Miles Individual Corporate OfficerBoard Member Jan 1, 2025
Massac Memorial Hospital Organization, Metropolis, IL 5% Or Greater Direct Ownership Interest Feb 1, 2006 100%
Operational/Managerial Control Feb 1, 2006
Cheryl Vanderford Individual Corporate OfficerBoard Member Jan 1, 2025
Patrick Howell Individual Corporate OfficerBoard Member Jan 1, 2025
Donald E Robbins Individual Corporate DirectorCeo Jan 1, 2025
W-2 Managing EmployeeCeo Jan 1, 2025
Amanda Hannan Individual Corporate OfficerBoard Member Jan 1, 2025
Jonathan E Walters Individual Corporate DirectorCmo Jan 1, 2025
W-2 Managing EmployeeCmo Jan 1, 2025
Larry Sommer Individual Corporate OfficerBoard Member Jan 1, 2025
Ricky Griffey Individual Corporate OfficerBoard Member Jan 1, 2025
Keith Jennings Individual Corporate OfficerBoard Member Jan 1, 2025

Owners & managing parties with NPI records 7

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

All facility ownership & control disclosures 3

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

FacilityTypeRoleSince
Massac Memorial HospitalMetropolis, IL, CCN 141323 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Oct 18, 2007
Oct 18, 2007
Massac Memorial HospitalMetropolis, IL, CCN 14Z323 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Feb 1, 2003
Feb 1, 2003
Massac Memorial Integrated Care ClinicMetropolis, IL, CCN 148618 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2020

Owned or controlled facilities with NPI records 3

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

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754265600000",
    "number": "1740355809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 790",
            "city": "METROPOLIS",
            "state": "IL",
            "postal_code": "629600790",
            "telephone_number": "618-524-2176",
            "fax_number": "618-524-4131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 W 10TH ST STE A&B",
            "city": "METROPOLIS",
            "state": "IL",
            "postal_code": "629602480",
            "telephone_number": "618-524-2176",
            "fax_number": "618-524-4131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASSAC MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2025-08-04",
        "certification_date": "2025-08-04",
        "status": "A",
        "authorized_official_last_name": "GOINES",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "618-524-2176",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IL",
            "license": "0001420",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Massac Memorial Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Massac Memorial Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Metropolis, IL

Sources for this page

Verify at the official NPI Registry.