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Southern Illinois Healthcare Foundation, Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Millstadt, IL

NPI 1811236458 · NPPES record last updated Feb 1, 2013

Key facts

NPI
1811236458
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC
Practice address
60 Regency PL
Millstadt, IL 62260-2210
Phone
(618) 476-9177
Fax
(618) 476-1890
NPI assigned
Feb 1, 2013
Organization subpart
No

Authorized official

Name
Larry McCulley
Title
Ceo
Phone
(618) 332-0694

Corporate family (same tax ID) 37

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

View all 37

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

  • Taylor M O'Neil, MD Family Medicine Physician · Scott Air Force Base, IL · NPI 1295361517
    NPD FAMILY MEDICINE

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in IL

Federally qualified health center certification: CCN 141187

Legal name
SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC
Doing business as
SIHF HEALTHCARE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 20, 2013
Last certification
Mar 20, 2013
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Sep 27, 1985 in IL
Enrollment address
60 Regency PL
Millstadt, IL 62260-2210

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Percy McKinney
Individual 		Corporate Director
Board Member		 Apr 22, 2024
Walter Hunter
Individual 		Corporate Officer
Vice Chairperson		 Feb 1, 2008
Gerard Hasenstab
Individual 		Corporate Director
Board Member		 Jan 1, 2019
Dale Fiedler
Individual 		Corporate Director
Board Member		 Jan 1, 2020
Debra Reed
Individual 		Corporate Director
Board Member		 Jan 1, 2021
Larry W McCulley
Individual 		Corporate Officer
Chief Executive Officer		 Apr 1, 2010
Kenneth Hall
Individual 		Corporate Director
Board Member		 Apr 1, 2015
Zoila Marty
Individual 		Corporate Director
Board Member		 Sep 1, 2005
Ethel Manager
Individual 		Corporate Officer
Chairperson		 May 1, 1996
Crysten Calvert
Individual 		Corporate Officer
Vice Chairperson		 Jan 1, 2023
Daniel Winkle
Individual 		W-2 Managing Employee
Ad;		 May 1, 2025
Anna Marie Nelson
Individual 		Corporate Director
Board Member		 Jan 1, 2010
Richard Sinclair
Individual 		Corporate Director
Board Member		 Aug 1, 2006
Darrel Sterling
Individual 		Corporate Director
Board Member		 Jan 1, 2023
Irma Golliday
Individual 		Corporate Director
Board Member		 Aug 1, 1999

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Touchette Regional Hospital Inc
Cahokia Heights, IL · CCN 140077		 Hospital Operational/Managerial Control Jun 30, 2009
Touchette Regional Hospital Inc
Cahokia Heights, IL · CCN 14S077		 Hospital Operational/Managerial Control Jun 30, 2009

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031126000641 IL Part B Supplier - Clinic/Group Practice 1456256874 Receives reassigned benefits from 170 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: East Saint Louis, IL; Effingham, IL; Fairmont City, IL; Glen Carbon, IL; Granite City, IL; Greenup, IL; Mattoon, IL; Millstadt, IL…
O20130308000481 IL Part a Provider - Federally Qualified Health Center (FQHC) 1456256874 Practice locations: Millstadt, IL

National Provider Directory

Tax ID family
Southern Illinois Hthca (38 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X IL
Federally Qualified Health Center (FQHC) 261QF0400X IL Yes

Addresses

Primary practice location

60 Regency PL
Millstadt, IL 62260-2210

Mailing address

2041 Goose Lake Rd
Sauget, IL 62206-2822
Phone (618) 332-0953

Other names

  • Millstadt Medical Clinic Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 1, 2013.

{
    "created_epoch": "1359676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1359676800000",
    "number": "1811236458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2041 GOOSE LAKE RD",
            "city": "SAUGET",
            "state": "IL",
            "postal_code": "622062822",
            "telephone_number": "618-332-0953",
            "fax_number": "618-332-2487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 REGENCY PL",
            "city": "MILLSTADT",
            "state": "IL",
            "postal_code": "622602210",
            "telephone_number": "618-476-9177",
            "fax_number": "618-476-1890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS HEALTHCARE FOUNDATION, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-02-01",
        "last_updated": "2013-02-01",
        "status": "A",
        "authorized_official_last_name": "MCCULLEY",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "618-332-0694"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Millstadt Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Millstadt, IL

All providers in Millstadt, IL · Federally Qualified Health Center (FQHC) in Illinois

Sources for this page

Verify at the official NPI Registry.