NPIMap

Organization Active NPI

Graham Hospital Association

Doing business as Graham Medical Group Farmington

  • Rural Health Clinic/Center
  • Farmington, IL
National Provider Identifier
1841436268
Registry record updated Oct 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GRAHAM HOSPITAL ASSOCIATION
Doing business as
Graham Medical Group Farmington
Practice address
601 E Fort St
Farmington, IL 61531-1338
Phone
(309) 245-2406
Fax
(309) 245-2428
NPI assigned
Jan 7, 2009
Last updated
Oct 23, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2018

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

Authorized official

Name
Julie Reeder
Title
VP of Finance/Cfo
Phone
(309) 647-5240

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

601 E Fort St
Farmington, IL 61531-1338

Mailing address

180 S Main St
Canton, IL 61520-2608
Phone (309) 647-0201

Other names 1

  • Graham Medical Group Farmington Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040510000873 IL Part B Supplier - Clinic/Group Practice 2769375021 Receives reassigned benefits from 139 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Galesburg, IL; Williamsfield, IL; Macomb, IL; Lewistown, IL; Glasford, IL; Farmington, IL; Elmwood, IL; Canton, IL
O20080812000150 IL Part A Provider - Rural Health Clinic 2769375021 2 other NPIs on this enrollment
Practice locations: Farmington, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841436268. Details of each certification follow.

Rural health clinic certification: CCN 143494

Legal name
GRAHAM HOSPITAL ASSOCIATION
Doing business as
GRAHAM MEDICAL GROUP FARMINGTON
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 1, 2008
Last certification
Aug 20, 2020
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Nov 21, 1905 in IL
Enrollment address
601 E Fort St
Farmington, IL 61531-1338
Related CCNs
140001

Other NPIs with the same Medicare PAC ID 14

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

View all 14

Other NPIs on the same Medicare enrollment 13

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

View all 13

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0906749Graham Medical Group - Farmington601 E Fort St, Farmington, IL 61531Certificate of waiverJul 5, 2027

National Provider Directory

National Provider Directory
Tax ID family
Graham Hospital22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

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

View all 21

Locations

210 W Walnut St
Canton, IL 61520
Phone (309) 647-5240

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Allison Sours Individual Corporate OfficerPresident and Ceo Jan 5, 2026
W-2 Managing EmployeePresident & Ceo Jan 5, 2026
Operational/Managerial ControlPresident & Ceo Jan 5, 2026
Morris D Lee Individual Corporate DirectorBoard Member Jan 1, 2019
William Carlberg Individual Corporate DirectorBoard Member Jan 1, 2022
Kenneth Krock Individual Corporate DirectorBoard Member Jan 1, 2021
Terry Moss Individual Corporate DirectorBoard Member Jan 1, 2021
Janis Blout Individual Corporate DirectorBoard Member Jan 1, 2019
Erin Elizabeth Bailey Individual Corporate DirectorBoard Member Jul 1, 2025
Kevin Meade Individual Corporate DirectorBoard Member Jan 1, 2020
Patrick B Renick Individual Corporate DirectorBoard Member Jan 1, 2019
Sarah Keefer Individual Corporate DirectorBoard Member Jul 1, 2025
Julie Reeder Individual Corporate OfficerVP of Finance/Cfo Mar 6, 2017

Owners & managing parties with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1231286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540252800000",
    "number": "1841436268",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "180 S MAIN ST",
            "city": "CANTON",
            "state": "IL",
            "postal_code": "615202608",
            "telephone_number": "309-647-0201",
            "fax_number": "309-649-5302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 E FORT ST",
            "city": "FARMINGTON",
            "state": "IL",
            "postal_code": "615311338",
            "telephone_number": "309-245-2406",
            "fax_number": "309-245-2428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAHAM HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-07",
        "last_updated": "2018-10-23",
        "status": "A",
        "authorized_official_last_name": "REEDER",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "VP OF FINANCE/CFO",
        "authorized_official_telephone_number": "309-647-5240"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Graham Medical Group Farmington",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Farmington, IL

Sources for this page

Verify at the official NPI Registry.