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Organization Active NPI

Crawford Hospital District

Doing business as Crawford Hospital District DBA CMH Rural Health Oblong

  • Rural Health Clinic/Center
  • Oblong, IL
National Provider Identifier
1790769073
Registry record updated Jun 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CRAWFORD HOSPITAL DISTRICT
Doing business as
Crawford Hospital District DBA CMH Rural Health Oblong
Practice address
1366 East 1050TH Ave
Oblong, IL 62449-1426
Phone
(618) 592-3119
Fax
(618) 546-2648
NPI assigned
Dec 1, 2005
Last updated
Jun 24, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
CRAWFORD HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 24, 2014

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

Authorized official

Name
Mr. Chris Bautista
Title
Practice Management Officer
Phone
(618) 546-2460

Specialties & licenses 1

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

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 1

IdentifierTypeStateIssuer
143488OtherILMEDICARE

Other names 1

  • Crawford Hospital District DBA CMH Rural Health Oblong Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060906000380 IL Part A Provider - Rural Health Clinic 7719898071 Practice locations: Oblong, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790769073. Details of each certification follow.

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
GovernmentNon-profit
Enrollment address
1366 E 1050TH Ave
Oblong, IL 62449-2409
Related CCNs
141343

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

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Crawford Memorial Emerg11 organizations share this tax ID, including this one
Part of
Crawford Memorial Emerg

Other organizations with this tax ID 10

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

Locations

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 400
Robinson, IL 62454

1101 N Allen St
Ste 600
Robinson, IL 62454

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Ovation Health Organization, Brentwood, TN Management services company Operational/Managerial Control Mar 8, 2023
Douglas C Florkowski Individual Contracted Managing EmployeeCeo Jul 17, 2017
Judith K Adams Individual Corporate DirectorBoard Member Jan 12, 2005
Mitzi S Martin Individual Corporate DirectorBoard Member Jan 1, 2004
John W Daugherty Individual Corporate DirectorBoard Member Feb 19, 2009
Robert K Quick Individual Corporate DirectorBoard Member Feb 17, 2021
Ellen M Maxwell Individual W-2 Managing EmployeeDirector of Clinic Systems, Dele Aug 7, 2017
Stewart J Schutte Individual Corporate DirectorBoard Member Sep 29, 2017
Sandra S Steffey Individual W-2 Managing EmployeeChief Practice Management Office Sep 1, 2017
Gregory P Kastner Individual Corporate DirectorBoard Member Feb 15, 2006
Wanda S James Individual Corporate DirectorBoard Member Jan 1, 2004
QHR Health LLC Organization, Brentwood, TN Management services company Operational/Managerial Control Mar 8, 2023
Crawford Hospital District Organization, Robinson, IL Created for acquisition, Non-profit 5% Or Greater Direct Ownership Interest Jul 31, 2006
Operational/Managerial Control Aug 6, 2013 100%
Melissa York Individual Corporate DirectorBoard Member Jul 18, 2024
John M Harbor Individual Contracted Managing Employee May 22, 2023
Thomas a Moore Individual Corporate DirectorBoard Member Mar 21, 2018

Owners & managing parties with NPI records 8

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

  • Crawford Hospital District

    dba Crawford Memorial Hospital and Health Services

    • Critical Access Hospital
    • Robinson, IL
    • NPI 1265493720

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Crawford Hospital District

    dba Crawford Memorial Hospital

    • Rural Health Clinic/Center
    • Robinson, IL
    • NPI 1356325633

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Crawford Hospital District

    dba CMH Rural Health - Med Center

    • Rural Health Clinic/Center
    • Robinson, IL
    • NPI 1356581540

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Crawford Hospital District

    dba Crawford Memorial Hospital D/B/a CMH Palestine Rural Health

    • Rural Health Clinic/Center
    • Palestine, IL
    • NPI 1538105523

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Crawford Hospital District

    dba Crawford Memorial Hospital and Health Services

    • Home Health Agency
    • Robinson, IL
    • NPI 1669438750

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Crawford Hospital District

    dba Crawford Memorial Hospital and Health Services

    • Medicare Defined Swing Bed Hospital Unit
    • Robinson, IL
    • NPI 1700842887

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Crawford Hospital District

    dba Crawford Memorial Hospital

    • Internal Medicine Physician
    • Robinson, IL
    • NPI 1861423287

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Gregory Paul Kastner, MD
    • Internal Medicine Physician
    • Robinson, IL
    • NPI 1659361525

    Corporate Director

    CMS ownership

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
Crawford Memorial HospitalRobinson, IL, CCN 141343 Hospital 5% Or Greater Direct Ownership Interest (100%) Jul 1, 1966
Crawford Memorial HospitalRobinson, IL, CCN 14Z343 Hospital Operational/Managerial Control (100%) Aug 9, 2017
Crawford Memorial Hospital Home HealthRobinson, IL, CCN 147175 Home health agency Operational/Managerial Control (100%) Aug 9, 2017
Crawford Memorial HospitalRobinson, IL, CCN 143429 Rural health clinic Operational/Managerial Control (100%) Aug 16, 2012
CMH Rural Health- PalestinePalestine, IL, CCN 143486 Rural health clinic Operational/Managerial Control (100%) Aug 13, 2013
CMH Rural Health - Med CenterRobinson, IL, CCN 148611 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 29, 2023
Nov 1, 2019

Owned or controlled facilities with NPI records 7

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

Facilities with the same owner 22

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

View all 22

Practitioners & affiliated clinicians

Practitioners 35

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.

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1133395200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403568000000",
    "number": "1790769073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 N ALLEN ST",
            "city": "ROBINSON",
            "state": "IL",
            "postal_code": "624541114",
            "telephone_number": "618-592-3119",
            "fax_number": "618-546-2648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1366 EAST 1050TH AVE",
            "city": "OBLONG",
            "state": "IL",
            "postal_code": "624491426",
            "telephone_number": "618-592-3119",
            "fax_number": "618-546-2648"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRAWFORD HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CRAWFORD HOSPITAL DISTRICT",
        "enumeration_date": "2005-12-01",
        "last_updated": "2014-06-24",
        "status": "A",
        "authorized_official_last_name": "BAUTISTA",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "PRACTICE MANAGEMENT OFFICER",
        "authorized_official_telephone_number": "618-546-2460",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "143488",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crawford Hospital District DBA CMH Rural Health Oblong",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oblong, IL

Sources for this page

Verify at the official NPI Registry.