NPIMap

Organization Active NPI

Board of Trustees of Southern Illinois University

  • Federally Qualified Health Center (FQHC)
  • Taylorville, IL
National Provider Identifier
1851934871
Registry record updated Jan 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Practice address
303 E Bidwell St
Taylorville, IL 62568-1363
Phone
(217) 824-3566
NPI assigned
Oct 22, 2019
Organization subpart
Yes
Parent organization
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITYAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Iris Wesley
Title
Ceo
Phone
(217) 545-8000

Owners & managing parties with NPI records 18

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

Owned or controlled facilities with NPI records 11

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

Other NPIs with the same Medicare PAC ID 18

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

Corporate family (same tax ID) 28

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

View all 28

Facilities with the same owner 10

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

Practitioners 139

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

View all 139

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
14D2158346S I U Center for Family Medicine - Taylorville303 E Bidwell, Taylorville, IL 62568Certificate of waiverNov 26, 2026

Medicare participation

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

Federally qualified health center certification: CCN 781937

Medicare enrollment files
Legal name
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
Doing business as
SIU CENTER FOR FAMILY MEDICINE-TAYLORVILLE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 10, 2020
Last certification
Mar 10, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Nov 15, 2019 in IL
Enrollment address
303 E Bidwell St
Taylorville, IL 62568-1363

All disclosed owners & managing parties 13

Medicare enrollment files

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

NameRoleSinceShare
Nancy S Zimmers Individual Corporate Director Jan 1, 2014
Iris E Wesley Individual Corporate Officer Nov 15, 2019
Corporate Director Nov 15, 2019
W-2 Managing EmployeeCeo Nov 15, 2019
Drusilla P Lobmaster Individual Corporate Director Jul 1, 2015
Keith Edward Rechner Individual Corporate OfficerPresident Jul 1, 2015
Veatrice G Crawford Individual Corporate OfficerSecretary Jul 1, 2012
Stuart H Shiffman Individual Corporate Director Nov 15, 2019
Board of Trustees of Southern Illinois University Organization, Taylorville, IL Non-profit Operational/Managerial Control Mar 10, 2020 100%
Jan R Gambach Individual Corporate Director Jul 1, 2012
Julie Kappes Individual Corporate Director Apr 1, 2017
Zevernett Holloway Individual Corporate Director Apr 1, 2017
Stephanie K Standish Individual Corporate Director Jul 1, 2012
Marcheta Hays Individual Corporate Director Jul 1, 2017
Waverly Robinson Individual Corporate OfficerImmediate Past President Feb 1, 2022

All facility ownership & control disclosures 11

Medicare enrollment files

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

FacilityTypeRoleSince
Siu Center for Family MedicineSpringfield, IL, CCN 141168 Federally qualified health center Operational/Managerial Control (100%) Jun 8, 2012
Siu Quincy Family MedicineQuincy, IL, CCN 781837 Federally qualified health center Operational/Managerial Control (100%) Jun 8, 2012
Siu Center for Family Medicine - LincolnLincoln, IL, CCN 781871 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2012
Board of Trustees of Southern Illinois UniversityDecatur, IL, CCN 781876 Federally qualified health center Operational/Managerial Control Oct 1, 2012
Siu Center for Family Medicine - IwcSpringfield, IL, CCN 781897 Federally qualified health center Operational/Managerial Control (100%) Aug 1, 2017
Siu Center for Family Medicine-Transitions of Western IllinoisQuincy, IL, CCN 781904 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Apr 2, 2018
Apr 2, 2018
Siu Center for Family Medicine - CarbondaleCarbondale, IL, CCN 781933 Federally qualified health center Operational/Managerial Control (100%) Oct 1, 2012
Board of Trustees of Southern Illinois UniversityPittsfield, IL, CCN 781942 Federally qualified health center Other (100%) Oct 1, 2012
Siu Center for Family Medicine-JacksonvilleJacksonville, IL, CCN 781066 Federally qualified health center Operational/Managerial Control Oct 1, 2012
Siu Center for Healthy Aging and WellnessSpringfield, IL, CCN 141809 Federally qualified health center Operational/Managerial Control Oct 1, 2012
Siu Center for Family Medicine - Sangamon County HealthSpringfield, IL, CCN 781147 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Oct 1, 2012
Oct 1, 2012

Medicare enrollment records 1

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20200309002148 IL Part a Provider - Federally Qualified Health Center (FQHC) 4486667888 Practice locations: Taylorville, IL

National Provider Directory

National Provider Directory
Tax ID family
DRS Herald and Thompson (29 organizations share this tax ID)
Part of
DRS Herald and Thompson

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Primary Care Clinic/Center 261QP2300X

Addresses

NPPES NPI Registry

Primary practice location

303 E Bidwell St
Taylorville, IL 62568-1363

Mailing address

PO Box 19639
Springfield, IL 62794-9639
Phone (217) 545-8000

Other names 1

NPPES NPI Registry
  • SIU Center for Family Medicine - Taylorville Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 9, 2025.

{
    "created_epoch": "1571702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736380800000",
    "number": "1851934871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19639",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949639",
            "telephone_number": "217-545-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 E BIDWELL ST",
            "city": "TAYLORVILLE",
            "state": "IL",
            "postal_code": "625681363",
            "telephone_number": "217-824-3566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY",
        "enumeration_date": "2019-10-22",
        "last_updated": "2025-01-09",
        "certification_date": "2025-01-09",
        "status": "A",
        "authorized_official_last_name": "WESLEY",
        "authorized_official_first_name": "IRIS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "217-545-8000"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SIU Center for Family Medicine - Taylorville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Taylorville, IL

Sources for this page

Verify at the official NPI Registry.