NPIMap

Organization Active NPI

Massac Memorial Hospital

  • Critical Access Hospital
  • Metropolis, IL
National Provider Identifier
1790788578
Registry record updated Dec 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
0001420 Issued in IL
Legal business name
MASSAC MEMORIAL HOSPITAL
Practice address
28 Chick St
Metropolis, IL 62960-2467
Phone
(618) 524-2176
Fax
(618) 524-4131
NPI assigned
May 24, 2005
Last updated
Dec 21, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
MASSAC COUNTY HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 21, 2023

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

Authorized official

Name
Mrs. Lynn Goines
Title
Cfo
Phone
(618) 524-2176

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 0001420 IL Primary
Skilled Nursing Facility 314000000X NU

Addresses

Primary practice location

28 Chick St
Metropolis, IL 62960-2467

Mailing address

PO Box 850
28 Chick St
Metropolis, IL 62960-0850
Phone (618) 524-2176

Other identifiers 9

IdentifierTypeStateIssuer
0140042MedicaidTN
037520699OtherENERGY EMPLOYEES OCCUP IL
3582OtherTNBLUE CROSS
6415006OtherILBLUE SHIELD ILLINOIS
111575OtherHEALTHLINK
317OtherILBLUE CROSS ILLINOIS
13019MedicaidIL
HEALTH ALLIANCEOther000795
01330034MedicaidKY

Other names 1

  • Massac Memorial Hospital Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040322000487 IL Part B Supplier - Clinic/Group Practice 3072422799 Receives reassigned benefits from 18 practitioners
3 other NPIs on this enrollment
Practice locations: Metropolis, IL
O20071107000747 IL Part A Provider - Critical Access Hospital 3072422799 Receives reassigned benefits from 13 practitioners
Practice locations: Metropolis, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790788578. Details of each certification follow.

Hospital certification: CCN 141323

Legal name
MASSAC MEMORIAL HOSPITAL
Doing business as
MASSAC MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Feb 1, 2003
Last certification
Nov 21, 2024
Beds
25
Ownership / control type
Hospital district or authority
Organization structure
GovernmentNon-profit
Enrollment address
28 Chick St
Metropolis, IL 62960-2467

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

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Massac Memorial HospitalCCN 141323 · All quality measures
Overall star rating
2 of 5
Type
Critical Access Hospitals
Ownership
Government - Hospital District or Authority
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
Massac Memorial Hospital

Locations

1204 W 10th St
Ste C
Metropolis, IL 62960
Phone (618) 524-2182

28 Chick St
Ste 100
Metropolis, IL 62960
Phone (618) 524-8381

Interoperability endpoints

  • Direct secure messaging: adamconnell@massac.medalliesdirect.net
  • Direct secure messaging: amandagaudy@massac.medalliesdirect.net
  • Direct secure messaging: christykennedy@massac.medalliesdirect.net
  • Direct secure messaging: haleyherndon@massac.medalliesdirect.net
  • Direct secure messaging: jameshawkins@massac.medalliesdirect.net
  • Direct secure messaging: jonathanwalters@massac.medalliesdirect.net
  • Direct secure messaging: tammypittayathikhun@massac.medalliesdirect.net
  • Direct secure messaging: taracrumble@massac.medalliesdirect.net
  • Direct secure messaging: terrybrown@massac.medalliesdirect.net

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Lynn Ann Goines Individual Corporate OfficerChief Financial Officer Apr 1, 2018
Corporate DirectorChief Financial Officer Apr 1, 2018
W-2 Managing EmployeeChief Financial Officer Apr 1, 2018
Bharat K Patel Individual Corporate DirectorBoard Member Jan 1, 2024
Maxine Russell Individual Corporate DirectorBoard Member Jan 1, 2024
Hailey Miles Individual Corporate DirectorBoard Member Jan 1, 2024
Massac Memorial Hospital Organization, Metropolis, IL 5% Or Greater Direct Ownership Interest Oct 18, 2007 100%
Operational/Managerial Control Oct 18, 2007
Cheryl Vanderford Individual Corporate DirectorBoard Member Jan 1, 2024
Patrick Howell Individual Corporate DirectorBoard Member Jan 1, 2024
Donald E Robbins Individual Corporate OfficerCeo Jun 5, 2023
Corporate DirectorCeo Jun 5, 2023
W-2 Managing EmployeeCeo Jun 5, 2023
Amanda Hannan Individual Corporate DirectorBoard Member Jan 1, 2024
Jonathan E Walters Individual W-2 Managing EmployeeCmo Jan 1, 2024
Larry Sommer Individual Corporate DirectorBoard Member Jan 1, 2024
Ricky Griffey Individual Corporate DirectorBoard Member Jan 1, 2024
Keith Jennings Individual Corporate DirectorBoard Member Jan 1, 2024

Owners & managing parties with NPI records 7

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
Massac Memorial HospitalMetropolis, IL, CCN 14Z323 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Feb 1, 2003
Feb 1, 2003
Massac Memorial Medical ClinicMetropolis, IL, CCN 143478 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Feb 1, 2006
Feb 1, 2006
Massac Memorial Integrated Care ClinicMetropolis, IL, CCN 148618 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2020

Owned or controlled facilities with NPI records 3

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

  • Massac Memorial Hospital

    dba Massac Memorial Inegrated Care Clinic

    • Rural Health Clinic/Center
    • Metropolis, IL
    • NPI 1356968275

    5% Or Greater Direct Ownership Interest

    CMS ownership
  • Massac Memorial Hospital

    dba Massac Memorial Medical Clinic

    • Rural Health Clinic/Center
    • Metropolis, IL
    • NPI 1740355809

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

    CMS ownership
  • Massac Memorial Hospital
    • Medicare Defined Swing Bed Hospital Unit
    • Metropolis, IL
    • NPI 1831226901

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

    CMS ownership

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 19

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 19

Affiliated clinicians 107

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 107

NPI Registry JSON

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703116800000",
    "number": "1790788578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 850",
            "address_2": "28 CHICK ST",
            "city": "METROPOLIS",
            "state": "IL",
            "postal_code": "629600850",
            "telephone_number": "618-524-2176",
            "fax_number": "618-524-4131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 CHICK ST",
            "city": "METROPOLIS",
            "state": "IL",
            "postal_code": "629602467",
            "telephone_number": "618-524-2176",
            "fax_number": "618-524-4131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASSAC MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MASSAC COUNTY HOSPITAL DISTRICT",
        "enumeration_date": "2005-05-24",
        "last_updated": "2023-12-21",
        "certification_date": "2023-12-21",
        "status": "A",
        "authorized_official_last_name": "GOINES",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "618-524-2176",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IL",
            "license": "0001420",
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0140042",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ENERGY EMPLOYEES OCCUP IL",
            "identifier": "037520699",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "3582",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD ILLINOIS",
            "identifier": "6415006",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "111575",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS ILLINOIS",
            "identifier": "317",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "13019",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "000795",
            "identifier": "HEALTH ALLIANCE",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01330034",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Massac Memorial Hospital",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Massac Memorial Hospital",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Metropolis, IL

Sources for this page

Verify at the official NPI Registry.