NPIMap

Organization Active NPI

Mendota Community Hospital

Doing business as OSF Healthcare - Medical Group - Spring Valley

  • Rural Health Clinic/Center
  • Spring Valley, IL
National Provider Identifier
1750139267
Registry record updated May 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MENDOTA COMMUNITY HOSPITAL
Doing business as
OSF Healthcare - Medical Group - Spring Valley
Practice address
415 E 2ND St
Spring Valley, IL 61362-1517
Phone
(815) 221-1340
NPI assigned
May 9, 2024
Last updated
May 9, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
OSF HEALTHCARE SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 9, 2024

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

Authorized official

Name
Robert Carl Sehring
Title
Chief Executive Officer
Phone
(309) 655-7689

Specialties & licenses 1

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

Addresses

Primary practice location

415 E 2ND St
Spring Valley, IL 61362-1517

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
999MedicaidIL

Other names 1

  • OSF Healthcare - Medical Group - Spring Valley Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240801003133 IL Part A Provider - Rural Health Clinic 2264335777 Practice locations: Spring Valley, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750139267. Details of each certification follow.

Rural health clinic certification: CCN 148668

Legal name
MENDOTA COMMUNITY HOSPITAL
Doing business as
OSF HEALTHCARE - MEDICAL GROUP - SPRING VALLEY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 6, 2024
Last certification
Sep 6, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Mar 24, 1944 in IL
Enrollment address
415 E 2ND St
Spring Valley, IL 61362-1517
Related CCNs
141310

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).

National Provider Directory

National Provider Directory
Tax ID family
ER Physciains GRP11 organizations share this tax ID, including this one
Part of
Osf Healthcare System

Other organizations with this tax ID 10

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

Locations

415 E 2nd St
Spring Valley, IL 61362
Phone (815) 221-1340

Ownership & related parties

All disclosed owners & managing parties 14

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 Officer Oct 1, 2006
Corporate Director Oct 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
Gerald J McShane Individual Corporate Director Sep 1, 1996
Osf Healthcare Ministries Organization, Peoria, IL Non-profit Operational/Managerial Control Nov 1, 2024
Kathleen F Williams Individual Corporate Officer Nov 1, 2014
Corporate Director Jan 1, 2003
Kirsten M Largent Individual Contracted Managing EmployeeCfo, Osf Healthcare System Nov 8, 2024
Corporate Officer Nov 8, 2024
Operational/Managerial Control Nov 8, 2024
Osf Healthcare System Organization, Peoria, IL Non-profit Operational/Managerial Control Apr 1, 2015
Robert C Sehring Individual Contracted Managing Employee Oct 20, 2017
Corporate OfficerChief Executive Officer Oct 20, 2017
Corporate DirectorCeo, Osf Healthcare System Oct 20, 2017
Operational/Managerial Control Oct 20, 2017
Judith a Duvall Individual Corporate Officer Oct 1, 2006
Corporate Director Oct 1, 1989
Carisa a Neumann Individual Corporate Director Jan 1, 2021
Brian J Silverstein Individual Corporate Director Oct 1, 2015
Paula K Selamat Individual Corporate Director Oct 6, 2024
Bridget J Meidl Individual Corporate Director Nov 1, 2014

Owners & managing parties with NPI records 1

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

Facilities with the same owner 76

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

View all 76

NPI Registry JSON

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

{
    "created_epoch": "1715212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715212800000",
    "number": "1750139267",
    "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": "415 E 2ND ST",
            "city": "SPRING VALLEY",
            "state": "IL",
            "postal_code": "613621517",
            "telephone_number": "815-221-1340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENDOTA COMMUNITY HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OSF HEALTHCARE SYSTEM",
        "enumeration_date": "2024-05-09",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A",
        "authorized_official_last_name": "SEHRING",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "CARL",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "309-655-7689"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "999",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OSF Healthcare - Medical Group - Spring Valley",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spring Valley, IL

Sources for this page

Verify at the official NPI Registry.