NPIMap

Organization Active NPI

Carle Eureka Hospital

Doing business as Carle Eureka Family Medicine - Eureka

  • Rural Health Clinic/Center
  • Eureka, IL
National Provider Identifier
1780101204
Registry record updated Aug 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CARLE EUREKA HOSPITAL
Doing business as
Carle Eureka Family Medicine - Eureka
Practice address
105 S Major St
Eureka, IL 61530-1246
Phone
(309) 467-4691
NPI assigned
Aug 25, 2017
Last updated
Aug 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 10, 2020

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

Authorized official

Name
Aron Klein
Title
Vice President Finance
Phone
(309) 268-2410

Specialties & licenses 1

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

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 1

  • Carle Eureka Family Medicine - Eureka Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200611002200 IL Part A Provider - Rural Health Clinic 3870914393 Practice locations: Eureka, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780101204. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Apr 13, 2020 in IL
Enrollment address
105 S Major St
Eureka, IL 61530-1246
Related CCNs
141309

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

Other NPIs with the same Medicare PAC ID 4

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0431542Carle Eureka Family Medicine - Eurkea105 S Major St, Eureka, IL 61530Certificate of waiverOct 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
Carle Eureka Hospital4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Robert M Cavagnol Individual Corporate OfficerPresident, Regional Feb 12, 2026
W-2 Managing Employee Feb 12, 2026
Charles a Dennis Individual Corporate DirectorBoard Member Jan 1, 2024
Delene Martin Bane Individual Corporate DirectorBoard Member Jan 1, 2025
Aron T Klein Individual Corporate OfficerCfo, VP of Finance Feb 25, 2025
Mary Kathleen Yoder Individual Corporate DirectorBoard Member Jan 1, 2018
Ronald L Greene Individual Corporate DirectorBoard Member/Board Chair Jan 1, 2015
Steven N Delis Individual Corporate DirectorBoard Member Sep 17, 2024
Carle Health - Central Region Organization, Urbana, IL Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2025 100%
Arlene Hosea Individual Corporate DirectorBoard Member Jan 1, 2026
Andrea M Kane Individual Corporate DirectorBoard Member Jan 1, 2021
Sue Ann Strayer Individual Corporate DirectorBoard Member Jan 1, 2018
The Carle Foundation Organization, Urbana, IL Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Jul 1, 2020 100%
Matthew Craig Kolb Individual Corporate DirectorPresident, Regional Jan 1, 2025
Jennifer Vance Individual Corporate DirectorBoard Member Jan 1, 2023
Stephen Christopher Pitcher Individual Corporate DirectorBoard Member Jan 1, 2026
John C Kell Individual Corporate DirectorBoard Member Jun 26, 2025
Brandon Bressner Individual Corporate DirectorBoard Member Jan 1, 2025

Owners & managing parties with NPI records 7

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

Facilities with the same owner 31

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

View all 31

Change-of-ownership history 2

DateEventCounterparty
Jul 1, 2020 Change of OwnershipThis provider was the buyer Advocate Eureka HospitalCCN 148581, IL, NPI 1780101204
Jul 1, 2020 Change of OwnershipThis provider was the seller Carle Eureka Family Medicine-EurekaCCN 148581, IL, NPI 1780101204

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": "1503619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597017600000",
    "number": "1780101204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1304 FRANKLIN AVE",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617613558",
            "telephone_number": "309-268-2410",
            "fax_number": "309-268-5703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 S MAJOR ST",
            "city": "EUREKA",
            "state": "IL",
            "postal_code": "615301246",
            "telephone_number": "309-467-4691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARLE EUREKA HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-25",
        "last_updated": "2020-08-10",
        "certification_date": "2020-08-10",
        "status": "A",
        "authorized_official_last_name": "KLEIN",
        "authorized_official_first_name": "ARON",
        "authorized_official_title_or_position": "VICE PRESIDENT FINANCE",
        "authorized_official_telephone_number": "309-268-2410"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carle Eureka Family Medicine - Eureka",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eureka, IL

Sources for this page

Verify at the official NPI Registry.