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Pana Community Hospital Association

Organization Active NPI Rural Health Clinic/Center · Assumption, IL

NPI 1760932248 · NPPES record last updated Oct 10, 2016

Key facts

NPI
1760932248
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
PANA COMMUNITY HOSPITAL ASSOCIATION
Practice address
118 N Walnut St
Assumption, IL 62510-1082
Phone
(217) 226-3133
Fax
(217) 226-4311
NPI assigned
Oct 10, 2016
Organization subpart
No

Authorized official

Name
Miss Lisa Bloemer
Title
Practice Manager
Phone
(217) 562-6246

Owners & managing parties with NPI records 9

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

Owned or controlled facilities with NPI records 2

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

Other NPIs with the same Medicare PAC ID 9

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

Corporate family (same tax ID) 16

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

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

Facilities with the same owner 2

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

Practitioners 55

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 55

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IL

Rural health clinic certification: CCN 148575

Legal name
PANA COMMUNITY HOSPITAL ASSOCIATION
Doing business as
COMMUNITY MEDICAL CLINIC OF ASSUMPTION
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 21, 2017
Last certification
Jun 21, 2017
Ownership / control type
2B
Organization structure
Corporation · Non-profit
Incorporated
Feb 8, 1966 in IL
Enrollment address
118 N Walnut St
Assumption, IL 62510-1082
Related CCNs
141341

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Pana Community Hospital Association
Organization · Nokomis, IL
Corporation, Non-profit 		5% Or Greater Direct Ownership Interest Dec 1, 2016 100%
Operational/Managerial Control Jul 19, 2022 100%
Lisa M Bloemer
Individual 		Corporate Officer
Practice Manager		 Jul 22, 2022 100%
W-2 Managing Employee
Practice Manager		 Dec 1, 2016 100%
Operational/Managerial Control
Practice Manager		 Jul 22, 2022 100%

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Community Medical Clinic of Nokomis
Nokomis, IL · CCN 148574		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Dec 1, 2016
Jul 19, 2022
Cowden Medical Group
Cowden, IL · CCN 148637		 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 1, 2022
Aug 1, 2022

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20170119001996 IL Part a Provider - Rural Health Clinic 3274437348 Practice locations: Assumption, IL

National Provider Directory

Tax ID family
Pana Internal Medicine (17 organizations share this tax ID)

Specialties & licenses

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

Addresses

Primary practice location

118 N Walnut St
Assumption, IL 62510-1082

Mailing address

101 E 9TH St
Pana, IL 62557-1716
Phone (217) 562-6246

Other names

  • Community Medical Clinic of Assumption Doing business as

Other providers in Assumption, IL

All providers in Assumption, IL · Rural Health Clinic/Center in Illinois

Sources for this page

Verify at the official NPI Registry.