NPIMap

Organization Active NPI

Massac Memorial Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Metropolis, IL
National Provider Identifier
1831226901
Registry record updated Aug 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
0001420 Issued in IL
Legal business name
MASSAC MEMORIAL HOSPITAL
Doing business as
Massac Memorial Hospital
Practice address
28 Chick St
Metropolis, IL 62960-2467
Phone
(618) 524-2176
Fax
(618) 524-4131
NPI assigned
Feb 27, 2007
Last updated
Aug 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2025

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

Authorized official

Name
Mrs. Lynn Goines
Title
Chief Financial Officer
Phone
(618) 524-2176

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 0001420 IL Primary

Addresses

Primary practice location

28 Chick St
Metropolis, IL 62960-2467

Mailing address

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

Other identifiers 4

IdentifierTypeStateIssuer
111575OtherILHEALTHLINK
01330034MedicaidKY
037520699OtherILENERGY EMPLOYEES OCCUP II
317OtherILBLUE CROSS

Other names 1

  • Massac Memorial Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071108000092 IL Part A Provider - Critical Access Hospital 3072422799 Practice locations: Metropolis, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831226901. Details of each certification follow.

Hospital certification: CCN 14Z323

Legal name
MASSAC MEMORIAL HOSPITAL
Organization structure
GovernmentNon-profit
Enrollment address
28 Chick St
Metropolis, IL 62960-2467
Other Hospital Practice Location

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).

National Provider Directory

National Provider Directory
Tax ID family
Massac Memorial Hospita4 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 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 OfficerCfo Apr 1, 2018
Corporate DirectorCfo Apr 1, 2018
W-2 Managing EmployeeCfo 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 Feb 1, 2003 100%
Operational/Managerial Control Feb 1, 2003
Cheryl Vanderford Individual Corporate DirectorBoard Member Jan 1, 2024
Patrick Howell Individual Corporate DirectorBoard Member Jan 1, 2024
Donald E Robbins Individual Corporate OfficerCeo Jan 1, 2024
Corporate DirectorCeo Jan 1, 2024
W-2 Managing EmployeeCeo Jan 1, 2024
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 141323 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Oct 18, 2007
Oct 18, 2007
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.

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1172534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754265600000",
    "number": "1831226901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 850",
            "address_2": "28 CHICK STREET",
            "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": "NO",
        "enumeration_date": "2007-02-27",
        "last_updated": "2025-08-04",
        "certification_date": "2025-08-04",
        "status": "A",
        "authorized_official_last_name": "GOINES",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "618-524-2176",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "IL",
            "license": "0001420",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "111575",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01330034",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ENERGY EMPLOYEES OCCUP II",
            "identifier": "037520699",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "317",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Massac Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Massac Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Metropolis, IL

Sources for this page

Verify at the official NPI Registry.