Crawford Hospital District
Organization Active NPI Rural Health Clinic/Center · Oblong, IL
NPI 1790769073 · NPPES record last updated Jun 24, 2014
Key facts
- NPI
- 1790769073
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- CRAWFORD HOSPITAL DISTRICT
- Practice address
- 1366 East 1050TH Ave
Oblong, IL 62449-1426 - Phone
- (618) 592-3119
- Fax
- (618) 546-2648
- NPI assigned
- Dec 1, 2005
- Organization subpart
- Yes
- Parent organization (as reported)
- CRAWFORD HOSPITAL DISTRICT
Authorized official
- Name
- Mr. Chris Bautista
- Title
- Practice Management Officer
- Phone
- (618) 546-2460
Owners & managing parties with NPI records 8
Owned or controlled facilities with NPI records 7
Other NPIs with the same Medicare PAC ID 7
Corporate family (same tax ID) 10
Related certifications (CCN) 2
Facilities with the same owner 22
Practitioners 82
-
Erin Elizabeth Adams, APRN
-
Clara Jean Barthelme, NP-C
-
Amanda M Bramham, MD
-
Joanna Edwards, MD
-
Cassi N Fiscus, FNP-C
-
Derek Keeler, APRN
-
Jenna L Kintner, NP
-
Jamie Knoblett, NP-C
-
Katherine Elaine Midgett, APRN
-
Keri Jane Mullins, APRN-BC
-
Katie Jo Parker, APRN, FNP-C
-
Preston S Reilly, MD
-
Robert Riggs, MD
-
Fred Dacon Scott, DO
-
Gary A Tennison, DO
-
Jill M Cucinella, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Rural health clinic certification: CCN 143488
- Legal name
- CRAWFORD HOSPITAL DISTRICT
- Doing business as
- CMH RURAL HEALTH- OBLONG
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jul 1, 2006
- Last certification
- Dec 22, 2020
- Ownership / control type
- 2B
- Organization structure
- Government · Non-profit
- Enrollment address
- 1366 E 1050TH Ave
Oblong, IL 62449-2409 - Related CCNs
- 141343
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Ovation Health |
Operational/Managerial Control | Mar 8, 2023 | |
| Douglas C Florkowski |
Contracted Managing Employee |
Jul 17, 2017 | |
| Judith K Adams |
Corporate Director |
Jan 12, 2005 | |
| Mitzi S Martin |
Corporate Director |
Jan 1, 2004 | |
| John W Daugherty |
Corporate Director |
Feb 19, 2009 | |
| Robert K Quick |
Corporate Director |
Feb 17, 2021 | |
| Ellen M Maxwell |
W-2 Managing Employee |
Aug 7, 2017 | |
| Stewart J Schutte |
Corporate Director |
Sep 29, 2017 | |
| Sandra S Steffey |
W-2 Managing Employee |
Sep 1, 2017 | |
| Gregory P Kastner |
Corporate Director |
Feb 15, 2006 | |
| Wanda S James |
Corporate Director |
Jan 1, 2004 | |
| QHR Health LLC |
Operational/Managerial Control | Mar 8, 2023 | |
| Crawford Hospital District |
5% Or Greater Direct Ownership Interest | Jul 31, 2006 | |
| Operational/Managerial Control | Aug 6, 2013 | 100% | |
| Melissa York |
Corporate Director |
Jul 18, 2024 | |
| John M Harbor |
Contracted Managing Employee | May 22, 2023 | |
| Thomas a Moore |
Corporate Director |
Mar 21, 2018 |
All facility ownership & control disclosures 6
| Facility | Type | Role | Since |
|---|---|---|---|
| Crawford Memorial Hospital |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Jul 1, 1966 |
| Crawford Memorial Hospital |
Hospital | Operational/Managerial Control (100%) | Aug 9, 2017 |
| Crawford Memorial Hospital Home Health |
Home health agency | Operational/Managerial Control (100%) | Aug 9, 2017 |
| Crawford Memorial Hospital |
Rural health clinic | Operational/Managerial Control (100%) | Aug 16, 2012 |
| CMH Rural Health- Palestine |
Rural health clinic | Operational/Managerial Control (100%) | Aug 13, 2013 |
| CMH Rural Health - Med Center |
Rural health clinic | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control (100%) |
Jul 29, 2023 Nov 1, 2019 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060906000380 | IL | Part a Provider - Rural Health Clinic | 7719898071 | Practice locations: Oblong, IL |
National Provider Directory
- Tax ID family
- Crawford Memorial Emerg
- Part of
- Crawford Memorial Emerg
Locations
2111 Lexington Ave
Lawrenceville, IL 62439
Phone (618) 943-6202
104 N Garfield St
Oblong, IL 62449
Phone (618) 592-3119
1000 N Allen St
Ste E
Robinson, IL 62454
1101 N Allen St
Ste 600
Robinson, IL 62454
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
1366 East 1050TH Ave
Oblong, IL 62449-1426
Mailing address
1000 N Allen St
Robinson, IL 62454-1114
Phone (618) 592-3119
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 143488 | Other | IL | MEDICARE |
Other names
- Crawford Hospital District DBA CMH Rural Health Oblong
Other providers in Oblong, IL
- Joanna Edwards
- Holly E Harmon
- Harmon'S Drug Store, Inc
- Harmon'S Drug Store, Inc
- Haven of Ridgeview, LLC
All providers in Oblong, 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 Jun 24, 2014. 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.