NPIMap

Organization Active NPI

Mason Hospital District

Doing business as Mason District Hospital

  • Critical Access Hospital
  • Havana, IL
National Provider Identifier
1902849649
Registry record updated Apr 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
0001412 Issued in IL
Legal business name
MASON HOSPITAL DISTRICT
Doing business as
Mason District Hospital
Practice address
615 N Promenade St
Havana, IL 62644-1015
Phone
(309) 543-4431
Fax
(309) 543-8528
NPI assigned
Jun 13, 2006
Last updated
Apr 9, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 9, 2010

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

Authorized official

Name
Mr. Robert J Stolba
Title
Chief Financial Officer
Phone
(309) 543-4431

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 0001412 IL Primary

Addresses

Primary practice location

615 N Promenade St
Havana, IL 62644-1015

Mailing address

615 N. Promenade
PO Box 530
Havana, IL 62644-0530
Phone (309) 543-4431

Other names 1

  • MASON DISTRICT HOSPITAL Doing business as

Medicare participation

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

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20030311000010 IL Part A Provider - Critical Access Hospital 2466360607 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
Practice locations: Havana, IL
O20040412000399 IL Part B Supplier - Clinic/Group Practice 2466360607 Receives reassigned benefits from 55 practitioners
3 other NPIs on this enrollment
Practice locations: Havana, IL; Manito, IL; Mason City, IL
O20111117000687 IL Part A Provider - Critical Access Hospital 2466360607 1 other NPI on this enrollment
Practice locations: Havana, IL

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1902849649. Details of each certification follow.

Hospital certification: CCN 141313

Legal name
MASON HOSPITAL DISTRICT
Doing business as
MASON DISTRICT HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jul 1, 2001
Last certification
May 20, 2015
Beds
25
Ownership / control type
Hospital district or authority
Organization structure
GovernmentNon-profit
Enrollment address
615 N Promenade St
Havana, IL 62644-1243
Main/Primary Hospital Location

Hospital certification: CCN 14Z313

Legal name
MASON HOSPITAL DISTRICT
Doing business as
MASON DISTRICT HOSPITAL
Organization structure
GovernmentNon-profit
Incorporated
in IL
Enrollment address
615 N Promenade St
Havana, IL 62644-1243
Main/Primary Hospital Location

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).

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Mason District HospitalCCN 141313 · 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

Locations

615 N Promenade St
#530
Havana, IL 62644
Phone (309) 543-4431

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Mason Hospital District Organization, Havana, IL 5% Or Greater Direct Ownership Interest Apr 23, 2014 100%
5% Or Greater Direct Ownership Interest Oct 1, 2011 100%
Leann K Bonnett Individual Corporate DirectorCfo Sep 3, 2015
W-2 Managing Employee Sep 3, 2015
Operational/Managerial Control Sep 3, 2015
Corporate OfficerCfo Sep 3, 2015
Douglas Kosier Individual Corporate OfficerCeo Jun 27, 2000
W-2 Managing Employee Jun 27, 2000
Operational/Managerial Control Jun 27, 2000

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 3

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

FacilityTypeRoleSince
Mason District Hospital Home HealthHavana, IL, CCN 147202 Home health agency 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Jan 1, 1966
Dec 29, 2009
Havana Medical AssociatesHavana, IL, CCN 143457 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2001
Manito Medical AssociatesManito, IL, CCN 148592 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2017

Owned or controlled facilities with NPI records 5

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

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 58

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 58

Affiliated clinicians 61

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

View all 61

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270771200000",
    "number": "1902849649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 N. PROMENADE",
            "address_2": "PO BOX 530",
            "city": "HAVANA",
            "state": "IL",
            "postal_code": "626440530",
            "telephone_number": "309-543-4431",
            "fax_number": "309-543-8528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 N PROMENADE ST",
            "city": "HAVANA",
            "state": "IL",
            "postal_code": "626441015",
            "telephone_number": "309-543-4431",
            "fax_number": "309-543-8528"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MASON HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2010-04-09",
        "status": "A",
        "authorized_official_last_name": "STOLBA",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "309-543-4431",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IL",
            "license": "0001412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MASON DISTRICT HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Havana, IL

Sources for this page

Verify at the official NPI Registry.