Mendota Community Hospital
Organization Active NPI Rural Health Clinic/Center · Spring Valley, IL
NPI 1750139267 · NPPES record last updated May 9, 2024
Key facts
- NPI
- 1750139267
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- MENDOTA COMMUNITY HOSPITAL
- Practice address
- 415 E 2ND St
Spring Valley, IL 61362-1517 - Phone
- (815) 221-1340
- NPI assigned
- May 9, 2024
- Organization subpart
- Yes
- Parent organization (as reported)
- OSF HEALTHCARE SYSTEM
Authorized official
- Name
- Robert Carl Sehring
- Title
- Chief Executive Officer
- Phone
- (309) 655-7689
Owners & managing parties with NPI records 1
Other NPIs with the same Medicare PAC ID 8
Corporate family (same tax ID) 10
Related certifications (CCN) 1
Facilities with the same owner 76
Practitioners 51
-
Shawn E Bailey, MD
-
Jamie Bond, FNP
-
Ricardo Joseph Calderon, M.D.
-
Keith Christensen, APN, FNP
-
Maddalena Davenport, APRN
-
Karen L Eggers, FNP-BC
-
Kara O Fess, MD
-
Angella Marie Greenwood, APN, FNP, BC
-
Gueorgui S Gueorguiev, M.D.
-
Lisa Kay Gustafson, MS/LCPC
-
Debra Herz, FNP-BC
-
Fazal Khan, M.D.
-
Korte B Knoblauch, PA-C
-
Hallie Konieczki, APN
-
Kellie Marie Kozlowski, PMHNP-BC
-
Marcela Renee Lemus, FNP-C
-
Britnae L Lewis, APRN, CNP
-
Leonardo Lopez, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
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
- Corporation · Non-profit
- Incorporated
- Mar 24, 1944 in IL
- Enrollment address
- 415 E 2ND St
Spring Valley, IL 61362-1517 - Related CCNs
- 141310
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Patricia a Brazeau |
Corporate Officer | Oct 1, 2006 | |
| Corporate Director | Oct 1, 2006 | ||
| Anne M Ziegler |
Corporate Director | Jan 1, 2021 | |
| Melanie R Mann |
Corporate Officer | Oct 6, 2024 | |
| Corporate Director | Oct 1, 2006 | ||
| Gerald J McShane |
Corporate Director | Sep 1, 1996 | |
| Osf Healthcare Ministries |
Operational/Managerial Control | Nov 1, 2024 | |
| Kathleen F Williams |
Corporate Officer | Nov 1, 2014 | |
| Corporate Director | Jan 1, 2003 | ||
| Kirsten M Largent |
Contracted Managing Employee |
Nov 8, 2024 | |
| Corporate Officer | Nov 8, 2024 | ||
| Operational/Managerial Control | Nov 8, 2024 | ||
| Osf Healthcare System |
Operational/Managerial Control | Apr 1, 2015 | |
| Robert C Sehring |
Contracted Managing Employee | Oct 20, 2017 | |
| Corporate Officer |
Oct 20, 2017 | ||
| Corporate Director |
Oct 20, 2017 | ||
| Operational/Managerial Control | Oct 20, 2017 | ||
| Judith a Duvall |
Corporate Officer | Oct 1, 2006 | |
| Corporate Director | Oct 1, 1989 | ||
| Carisa a Neumann |
Corporate Director | Jan 1, 2021 | |
| Brian J Silverstein |
Corporate Director | Oct 1, 2015 | |
| Paula K Selamat |
Corporate Director | Oct 6, 2024 | |
| Bridget J Meidl |
Corporate Director | Nov 1, 2014 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240801003133 | IL | Part a Provider - Rural Health Clinic | 2264335777 | Practice locations: Spring Valley, IL |
National Provider Directory
- Tax ID family
- Mary Chinn MD
- Part of
- Eastland Med Plaza Surg
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 999 | Medicaid | IL |
Other names
- OSF Healthcare - Medical Group - Spring Valley
Other providers in Spring Valley, IL
- Michael Allen Lewis
- Jane Loiselle
- Lynette Lucas
- Louis R Lukancic
- Jennifer L Maschmann
- Michael S Morrow
- Robert W Morrow III
- Amanda Neurohr
- Nicole Edith Norris
- Pack Machine Incorporated
All providers in Spring Valley, 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 May 9, 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.