Carle Eureka Hospital
Organization Active NPI Rural Health Clinic/Center · Eureka, IL
NPI 1780101204 · NPPES record last updated Aug 10, 2020
Key facts
- NPI
- 1780101204
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- CARLE EUREKA HOSPITAL
- Practice address
- 105 S Major St
Eureka, IL 61530-1246 - Phone
- (309) 467-4691
- NPI assigned
- Aug 25, 2017
- Organization subpart
- No
Authorized official
- Name
- Aron Klein
- Title
- Vice President Finance
- Phone
- (309) 268-2410
Owners & managing parties with NPI records 7
-
Steve Delis, MD
-
John C Kell, MD
-
Sue A Strayer, MD
-
Mary Kathleen Yoder, APRN, CNP
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 3
Related certifications (CCN) 1
Facilities with the same owner 31
Practitioners 11
-
Colby Lee Carr, MD
-
Kellie Dewitt, PHYSICIAN ASSISTANT
-
Shane C. Fogo, M.D.
-
Christopher R. Hughes, M.D.
-
Steven C. Ingalsbe, M.D.
-
Samantha A Leverton, APN
-
Jason Roach, PA-C
-
Samuel E. Steffen, M.D.
-
Nicholas Weber, DO
-
Steven K. Jones, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D0431542 | Carle Eureka Family Medicine - Eurkea | Certificate of waiver | Oct 22, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Rural health clinic certification: CCN 148581
- Legal name
- CARLE EUREKA HOSPITAL
- Doing business as
- CARLE EUREKA FAMILY MEDICINE-EUREKA
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Nov 29, 2017
- Last certification
- Nov 29, 2017
- Ownership / control type
- 2B
- Most recent change of ownership
- Jul 1, 2020 (1 total)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Apr 13, 2020 in IL
- Enrollment address
- 105 S Major St
Eureka, IL 61530-1246 - Related CCNs
- 141309
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Robert M Cavagnol |
Corporate Officer |
Feb 12, 2026 | |
| W-2 Managing Employee | Feb 12, 2026 | ||
| Charles a Dennis |
Corporate Director |
Jan 1, 2024 | |
| Delene Martin Bane |
Corporate Director |
Jan 1, 2025 | |
| Aron T Klein |
Corporate Officer |
Feb 25, 2025 | |
| Mary Kathleen Yoder |
Corporate Director |
Jan 1, 2018 | |
| Ronald L Greene |
Corporate Director |
Jan 1, 2015 | |
| Steven N Delis |
Corporate Director |
Sep 17, 2024 | |
| Carle Health - Central Region |
5% Or Greater Direct Ownership Interest | Jan 1, 2025 | 100% |
| Arlene Hosea |
Corporate Director |
Jan 1, 2026 | |
| Andrea M Kane |
Corporate Director |
Jan 1, 2021 | |
| Sue Ann Strayer |
Corporate Director |
Jan 1, 2018 | |
| The Carle Foundation |
5% Or Greater Indirect Ownership Interest | Jul 1, 2020 | 100% |
| Matthew Craig Kolb |
Corporate Director |
Jan 1, 2025 | |
| Jennifer Vance |
Corporate Director |
Jan 1, 2023 | |
| Stephen Christopher Pitcher |
Corporate Director |
Jan 1, 2026 | |
| John C Kell |
Corporate Director |
Jun 26, 2025 | |
| Brandon Bressner |
Corporate Director |
Jan 1, 2025 |
Change-of-ownership history
| Date | Event | Counterparty |
|---|---|---|
| Jul 1, 2020 | Change of Ownership |
Advocate Eureka Hospital |
| Jul 1, 2020 | Change of Ownership |
Carle Eureka Family Medicine-Eureka |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200611002200 | IL | Part a Provider - Rural Health Clinic | 3870914393 | Practice locations: Eureka, IL |
National Provider Directory
- Tax ID family
- Carle Eureka Hospital
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
105 S Major St
Eureka, IL 61530-1246
Mailing address
1304 Franklin Ave
Normal, IL 61761-3558
Phone (309) 268-2410
Other names
- Carle Eureka Family Medicine - Eureka
Other providers in Eureka, IL
- Bromenn Healthcare, Inc.
- Bromenn Physicians Management Corporation
- Joseph Gerard Burns
- Carle Eureka Hospital
- Carle Eureka Hospital
- Jason Collins
- County of Woodford Eureka Congerville Goodfld Dist 140
- David Howard Crenshaw
- Michael T Detweiler
- Victoria L Diekhoff
All providers in Eureka, 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 Aug 10, 2020. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.