NPIMap

Organization Active NPI

Pana Community Hospital Association

Doing business as Pana Medical Group

  • Rural Health Clinic/Center
  • Pana, IL
National Provider Identifier
1760940860
Registry record updated Oct 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PANA COMMUNITY HOSPITAL ASSOCIATION
Doing business as
Pana Medical Group
Practice address
217 S Locust St
Pana, IL 62557-1689
Phone
(217) 562-2143
Fax
(217) 562-2251
NPI assigned
Mar 7, 2019
Last updated
Oct 6, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2026

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

Authorized official

Name
Lori Anne Ade
Title
Practice Manager
Phone
(217) 562-2143

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

217 S Locust St
Pana, IL 62557-1689

Mailing address

217 S Locust St
Pana, IL 62557-1605
Phone (217) 562-2143

Other names 1

  • Pana Medical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190328001606 IL Part A Provider - Rural Health Clinic 3274437348 Practice locations: Pana, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1760940860. Details of each certification follow.

Rural health clinic certification: CCN 148633

Legal name
PANA COMMUNITY HOSPITAL ASSOCIATION
Doing business as
PANA MEDICAL GROUP
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 15, 2022
Last certification
Sep 15, 2022
Ownership / control type
2B
Organization structure
OtherNon-profit
Incorporated
Feb 8, 1966 in IL
Enrollment address
217 S Locust St
Pana, IL 62557-1605
Related CCNs
141341

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

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Pana Comm Hosp Respirat17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

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
David Slater Individual Corporate DirectorBoard Member May 1, 2017
Matt Beavers Individual Corporate DirectorBoard Member May 1, 2013
James E Moon Individual Corporate OfficerCfo Jun 6, 2016
Corporate DirectorCfo Jun 6, 2016
Charles O'Malley Individual Corporate DirectorBoard Member May 1, 2016
Larry Cearlock Individual Corporate DirectorBoard Member May 1, 2015
Amanda Richards Individual Corporate DirectorBoard Member May 1, 2018
Kenneth Flesch Individual Corporate DirectorBoard Member May 1, 2017
Jimmie Brewer Individual Corporate DirectorBoard Member May 1, 2016
Katrina J Casner Individual Corporate OfficerCeo/President May 5, 2016
W-2 Managing EmployeeCeo/President Jun 6, 2016
Rick Schmitz Individual Corporate DirectorBoard Member May 1, 2014
Lori a Ade Individual W-2 Managing EmployeePractice Manager Jul 2, 2018
David R Lett Individual Corporate DirectorBoard Member May 1, 2014
Gregory Holthaus Individual Corporate DirectorBoard Member May 1, 2015
Walter H Cunnington Individual Corporate DirectorBoard Member May 1, 2015

Owners & managing parties with NPI records 1

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
Community Medical Clinic of NokomisNokomis, IL, CCN 148574 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Dec 1, 2016
Jul 19, 2022
Community Medical Clinic of AssumptionAssumption, IL, CCN 148575 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Dec 1, 2016
Jul 19, 2022
Cowden Medical GroupCowden, IL, CCN 148637 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 1, 2022
Aug 1, 2022

Owned or controlled facilities with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1551916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791244800000",
    "number": "1760940860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "217 S LOCUST ST",
            "city": "PANA",
            "state": "IL",
            "postal_code": "625571605",
            "telephone_number": "217-562-2143",
            "fax_number": "217-562-2251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 S LOCUST ST",
            "city": "PANA",
            "state": "IL",
            "postal_code": "625571689",
            "telephone_number": "217-562-2143",
            "fax_number": "217-562-2251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANA COMMUNITY HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-07",
        "last_updated": "2026-10-06",
        "certification_date": "2026-10-06",
        "status": "A",
        "authorized_official_last_name": "ADE",
        "authorized_official_first_name": "LORI",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "217-562-2143"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pana Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pana, IL

Sources for this page

Verify at the official NPI Registry.