NPIMap

Organization Active NPI

Memorial Hospital

  • Critical Access Hospital
  • Chester, IL
National Provider Identifier
1851390132
Registry record updated Sep 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
0001495 Issued in IL
Legal business name
MEMORIAL HOSPITAL
Practice address
1900 State St
Chester, IL 62233-1116
Phone
(618) 826-4581
Fax
(618) 826-4813
NPI assigned
Jul 19, 2005
Last updated
Sep 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2022

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

Authorized official

Name
Ms. Morgan K Bendorf, CPA
Title
Cfo
Phone
(618) 826-4581

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 036051292 IL
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 036052369 IL
Family Medicine Physician 207Q00000X 036-051292 IL
Family Medicine Physician 207Q00000X 036-052369 IL
Family Medicine Physician 207Q00000X 036-130378 IL
Family Medicine Physician 207Q00000X 036-087561 IL
Family Medicine Physician 207Q00000X 036-141161 IL
Surgery Physician 208600000X 036-127160 IL
Surgery Physician 208600000X 036-046019 IL
Critical Access Hospital 282NC0060X 0001495 IL Primary
Pharmacy 333600000X 054017088 IL
Physician Assistant 363A00000X 085-003568 IL
Physician Assistant 363A00000X 085-003575 IL
Certified Registered Nurse Anesthetist 367500000X 041-149926 IL
Certified Registered Nurse Anesthetist 367500000X 209-009387 IL

Addresses

Primary practice location

1900 State St
Chester, IL 62233-1116

Mailing address

1900 State St
Chester, IL 62233-1116
Phone (618) 826-4581

Other identifiers 1

IdentifierTypeStateIssuer
0001495OtherILIDPH

Other names 1

  • Randolph Hospital District Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20031113000382 IL Part B Supplier - Clinic/Group Practice 5294649372 Receives reassigned benefits from 63 practitioners
Practice locations: Chester, IL
O20080529000078 IL Part A Provider - Critical Access Hospital 5294649372 Receives reassigned benefits from 53 practitioners
Practice locations: Chester, IL
O20080529000137 IL Part A Provider - Critical Access Hospital 5294649372 Practice locations: Chester, IL

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1851390132. Details of each certification follow.

Hospital certification: CCN 141338

Legal name
MEMORIAL HOSPITAL
Doing business as
RANDOLPH HOSPITAL DISTRICT
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Sep 1, 2004
Last certification
Nov 16, 2001
Beds
61
Ownership / control type
Hospital district or authority
Organization structure
CorporationNon-profit
Incorporated
Oct 12, 1962 in IL
Enrollment address
1900 State St
Chester, IL 62233-1116

Hospital certification: CCN 14Z338

Legal name
MEMORIAL HOSPITAL
Doing business as
RANDOLPH HOSPITAL DISTRICT
Organization structure
CorporationNon-profit
Incorporated
Oct 12, 1962 in IL
Enrollment address
1900 State St
Chester, IL 62233-1116

Hospital certification: CCN 140245

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MEMORIAL HOSPITAL
Certification status
Terminated Other: provider status change, Sep 1, 2004
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Nov 15, 2001
Beds
61
Ownership / control type
Hospital district or authority
Facility address
1900 State St
Chester, IL 62233

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

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Memorial HospitalCCN 141338 · All quality measures
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

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Mary Sulser Individual Corporate DirectorBoard Member Jul 6, 2015
Michael Vasquez Individual Corporate DirectorBoard Member Jun 21, 2012
Mary Brown Individual Corporate DirectorBoard Member Jul 6, 2015
Grant Deterding Individual Corporate DirectorBoard Member Jul 28, 2017
Evelyn Schuwerk Individual Corporate DirectorBoard Member Mar 4, 2011
Brett a Bollmann Individual W-2 Managing EmployeeChief Executive Officer Oct 1, 2013
Corporate OfficerChief Executive Officer Jun 1, 2015
W-2 Managing EmployeeCeo Jun 1, 2015
Mary Alice Welge Individual Corporate DirectorBoard Member Aug 12, 2016
Morgan K Bendorf Individual Corporate OfficerChief Financial Officer Oct 1, 2017
W-2 Managing EmployeeChief Financial Officer Oct 1, 2017
W-2 Managing EmployeeCfo Oct 1, 2017
Thomas Search Individual Corporate DirectorBoard Member Jun 24, 2011
Daniel R Colvis Individual Corporate DirectorBoard Member Mar 4, 2013

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Memorial HospitalChester, IL, CCN 148543 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2015
Memorial HospitalSteeleville, IL, CCN 148542 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2015

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 73

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 73

Affiliated clinicians 57

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

View all 57

NPI Registry JSON

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662076800000",
    "number": "1851390132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 STATE ST",
            "city": "CHESTER",
            "state": "IL",
            "postal_code": "622331116",
            "telephone_number": "618-826-4581",
            "fax_number": "618-826-4813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 STATE ST",
            "city": "CHESTER",
            "state": "IL",
            "postal_code": "622331116",
            "telephone_number": "618-826-4581",
            "fax_number": "618-826-4813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-19",
        "last_updated": "2022-09-02",
        "certification_date": "2022-09-02",
        "status": "A",
        "authorized_official_last_name": "BENDORF",
        "authorized_official_first_name": "MORGAN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "618-826-4581",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "IL",
            "license": "036051292",
            "primary": false
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "IL",
            "license": "036052369",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-051292",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-052369",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-130378",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-087561",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-141161",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036-127160",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036-046019",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IL",
            "license": "0001495",
            "primary": true
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "IL",
            "license": "054017088",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-003568",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-003575",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "041-149926",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209-009387",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDPH",
            "identifier": "0001495",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Randolph Hospital District",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Randolph Hospital District",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chester, IL

Sources for this page

Verify at the official NPI Registry.