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Organization Active NPI

McDonough County Hospital District

Doing business as McDonough District Hospital

  • Certified Registered Nurse Anesthetist
  • Macomb, IL
National Provider Identifier
1871704874
Registry record updated Oct 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
MCDONOUGH COUNTY HOSPITAL DISTRICT
Doing business as
McDonough District Hospital
Practice address
525 E Grant St
Macomb, IL 61455-3313
Phone
(309) 833-4101
NPI assigned
May 24, 2007
Last updated
Oct 17, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2023

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

Authorized official

Name
Brian E Dietz
Title
President, Ceo
Phone
(309) 833-4101

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

525 E Grant St
Macomb, IL 61455-3313

Mailing address

525 E Grant St
Macomb, IL 61455-3313
Phone (309) 833-4101

Other identifiers 1

IdentifierTypeStateIssuer
0005519699OtherILBLUE SHIELD GROUP

Other names 1

  • McDonough District Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040317000808 IL Part B Supplier - Clinic/Group Practice 0446140180 Receives reassigned benefits from 15 practitioners
Practice locations: Macomb, IL

Other NPIs with the same Medicare PAC ID 10

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

National Provider Directory

National Provider Directory
Tax ID family
McDonough County Hosp Dist20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

Ownership & related parties

All facility ownership & control disclosures 7

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

FacilityTypeRoleSince
McDonough District HospitalMacomb, IL, CCN 140089 Hospital 5% Or Greater Direct Ownership Interest (100%) Sep 30, 2018
McDonough District HospitalMacomb, IL, CCN 14U089 Hospital 5% Or Greater Direct Ownership Interest (100%) Jun 10, 2014
McDonough District Hospital Home HealthMacomb, IL, CCN 147293 Home health agency Operational/Managerial Control (100%) Oct 22, 2012
McDonough District HospitalMacomb, IL, CCN 141524 Hospice 5% Or Greater Direct Ownership Interest (100%) Jan 12, 1989
Bushnell Family PracticeBushnell, IL, CCN 148522 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2013
MDH Family Medicine/Convenience Care/Surgery/ENT ClinicMacomb, IL, CCN 148619 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2020
MDH Pediatric ClinicMacomb, IL, CCN 148617 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2020

Owned or controlled facilities with NPI records 7

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

Practitioners & affiliated clinicians

Practitioners 84

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 84

NPI Registry JSON

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697500800000",
    "number": "1871704874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 E GRANT ST",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614553313",
            "telephone_number": "309-833-4101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 E GRANT ST",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614553313",
            "telephone_number": "309-833-4101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCDONOUGH COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2023-10-17",
        "certification_date": "2023-10-17",
        "status": "A",
        "authorized_official_last_name": "DIETZ",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT, CEO",
        "authorized_official_telephone_number": "309-833-4101"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GROUP",
            "identifier": "0005519699",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McDonough District Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "McDonough District Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Macomb, IL

Sources for this page

Verify at the official NPI Registry.