NPIMap

Organization Active NPI

Schuyler County Hospital District

  • Rural Health Clinic/Center
  • Astoria, IL
National Provider Identifier
1871546465
Registry record updated Nov 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SCHUYLER COUNTY HOSPITAL DISTRICT
Practice address
135 W Broadway St
Astoria, IL 61501
Phone
(309) 329-2926
Fax
(309) 329-2656
NPI assigned
May 18, 2006
Organization subpart
Yes
Parent organization
SCHUYLER COUNTY HOSPITAL DISTRICTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 9, 2020

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

Authorized official

Name
Mrs. Tamra S Gadberry
Title
Chief Financial Officer
Phone
(217) 322-4321

Specialties & licenses 1

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

Addresses

Primary practice location

135 W Broadway St
Astoria, IL 61501

Mailing address

135 W Broadway St
Astoria, IL 61501-9634
Phone (309) 329-2926

Other names 1

  • COMMUNITY MEDICAL CLINIC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071120000012 IL Part A Provider - Rural Health Clinic 9638076474 Practice locations: Astoria, IL

Rural health clinic certification: CCN 143484

Legal name
SCHUYLER COUNTY HOSPITAL DISTRICT
Doing business as
COMMUNITY MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 1, 2006
Last certification
Jul 4, 2013
Ownership / control type
2B
Organization structure
OtherNon-profit
Enrollment address
135 W Broadway
Astoria, IL 61501-9634
Related CCNs
141333

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

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Sarah D Culbertson Memorial8 organizations share this tax ID, including this one
Part of
Sarah D Culbertson Memorial

Other organizations with this tax ID 7

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Tamra S Gadberry Individual Corporate OfficerChief Financial Officer Jul 1, 2017
W-2 Managing EmployeeChief Financial Officer Jul 1, 2017
Schuyler County Hospital District Health Center Organization, Beardstown, IL Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Nov 15, 2011 100%
Schuyler County Hospital District Organization, Rushville, IL 5% Or Greater Direct Ownership Interest May 1, 2004 100%
Gregg R Snyder Individual Corporate OfficerChief Executive Officer Oct 1, 2021
W-2 Managing EmployeeChief Executive Officer Oct 1, 2021

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Sarah D. Culbertson Memorial HospitalRushville, IL, CCN 141333 Hospital 5% Or Greater Direct Ownership Interest (100%) May 1, 2004
Sarah D Culbertson Memorial HospitalRushville, IL, CCN 14Z333 Hospital 5% Or Greater Direct Ownership Interest (100%) May 1, 2004
Elmer Hugh Taylor ClinicBeardstown, IL, CCN 143483 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2016
Rushville Family PracticeRushville, IL, CCN 148578 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Mar 3, 2008

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604880000000",
    "number": "1871546465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 W BROADWAY ST",
            "city": "ASTORIA",
            "state": "IL",
            "postal_code": "615019634",
            "telephone_number": "309-329-2926",
            "fax_number": "309-329-2656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 W BROADWAY ST",
            "city": "ASTORIA",
            "state": "IL",
            "postal_code": "61501",
            "telephone_number": "309-329-2926",
            "fax_number": "309-329-2656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCHUYLER COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SCHUYLER COUNTY HOSPITAL DISTRICT",
        "enumeration_date": "2006-05-18",
        "last_updated": "2020-11-09",
        "certification_date": "2020-11-09",
        "status": "A",
        "authorized_official_last_name": "GADBERRY",
        "authorized_official_first_name": "TAMRA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "217-322-4321",
        "authorized_official_name_prefix": "Mrs."
    },
    "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",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "COMMUNITY MEDICAL CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Astoria, IL

Sources for this page

Verify at the official NPI Registry.