NPIMap

Organization Active NPI

Pana Community Hospital Association

Doing business as Community Medical Clinic of Nokomis

  • Rural Health Clinic/Center
  • Nokomis, IL
National Provider Identifier
1861942344
Registry record updated Oct 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
PANA COMMUNITY HOSPITAL ASSOCIATION
Doing business as
Community Medical Clinic of Nokomis
Practice address
120 S Cedar St
Nokomis, IL 62075-1647
Phone
(217) 563-8363
Fax
(217) 563-8373
NPI assigned
Oct 10, 2016
Last updated
Oct 10, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2016

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

Authorized official

Name
Miss Lisa Marie Bloemer
Title
Practice Manager
Phone
(217) 562-6246

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X IL Primary

Addresses

Primary practice location

120 S Cedar St
Nokomis, IL 62075-1647

Mailing address

101 E 9TH St
Pana, IL 62557-1716
Phone (217) 562-6246

Other names 1

  • Community Medical Clinic of Nokomis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161114000039 IL Part A Provider - Rural Health Clinic 3274437348 Practice locations: Nokomis, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861942344. Details of each certification follow.

Rural health clinic certification: CCN 148574

Legal name
PANA COMMUNITY HOSPITAL ASSOCIATION
Doing business as
COMMUNITY MEDICAL CLINIC OF NOKOMIS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 29, 2017
Last certification
Jun 29, 2017
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Feb 8, 1966 in IL
Enrollment address
120 S Cedar St
Nokomis, IL 62075-1647
Related CCNs
141341

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

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Pana Comm Hosp Respirat17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Pana Community Hospital Association Organization, Pana, IL Corporation, Non-profit 5% Or Greater Direct Ownership Interest Dec 1, 2016 100%
Operational/Managerial Control Jul 19, 2022
Lisa M Bloemer Individual Corporate OfficerPractice Manager Jul 22, 2022 100%
W-2 Managing EmployeePractice Manager Dec 1, 2016 100%
Operational/Managerial ControlPractice Manager Jul 22, 2022 100%

Owners & managing parties with NPI records 9

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Community Medical Clinic of AssumptionAssumption, IL, CCN 148575 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Dec 1, 2016
Jul 19, 2022
Cowden Medical GroupCowden, IL, CCN 148637 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Aug 1, 2022
Aug 1, 2022

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

Practitioners 3

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": "1476057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476057600000",
    "number": "1861942344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E 9TH ST",
            "city": "PANA",
            "state": "IL",
            "postal_code": "625571716",
            "telephone_number": "217-562-6246",
            "fax_number": "217-562-6228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 S CEDAR ST",
            "city": "NOKOMIS",
            "state": "IL",
            "postal_code": "620751647",
            "telephone_number": "217-563-8363",
            "fax_number": "217-563-8373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANA COMMUNITY HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-10",
        "last_updated": "2016-10-10",
        "status": "A",
        "authorized_official_last_name": "BLOEMER",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "217-562-6246",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Medical Clinic of Nokomis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Nokomis, IL

Sources for this page

Verify at the official NPI Registry.