Mendota Community Hospital
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Mendota, IL
NPI 1922024843 · NPPES record last updated Apr 2, 2026
Key facts
- NPI
- 1922024843
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 275N00000X
- License
- 275N00000X (IL)
- Legal business name
- MENDOTA COMMUNITY HOSPITAL
- Practice address
- 1401 East 12TH Street
Mendota, IL 61342-9216 - Phone
- (815) 539-7461
- Fax
- (815) 538-5516
- NPI assigned
- Jul 14, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- OSF HEALTHCARE SYSTEM
Authorized official
- Name
- Kirsten Marie Largent
- Title
- Cfo
- Phone
- (309) 308-5255
Owners & managing parties with NPI records 1
Other NPIs with the same Medicare PAC ID 8
Related certifications (CCN) 1
Facilities with the same owner 76
Practitioners 51
-
Shawn E Bailey, MD
-
Jamie Bond, FNP
-
Ricardo Joseph Calderon, M.D.
-
Keith Christensen, APN, FNP
-
Maddalena Davenport, APRN
-
Karen L Eggers, FNP-BC
-
Kara O Fess, MD
-
Angella Marie Greenwood, APN, FNP, BC
-
Gueorgui S Gueorguiev, M.D.
-
Lisa Kay Gustafson, MS/LCPC
-
Debra Herz, FNP-BC
-
Fazal Khan, M.D.
-
Korte B Knoblauch, PA-C
-
Hallie Konieczki, APN
-
Kellie Marie Kozlowski, PMHNP-BC
-
Marcela Renee Lemus, FNP-C
-
Britnae L Lewis, APRN, CNP
-
Leonardo Lopez, M.D.
Affiliated clinicians 4
-
Grant M Reed, DO
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Hospital certification: CCN 14Z310
- Legal name
- MENDOTA COMMUNITY HOSPITAL
- Doing business as
- OSF SAINT PAUL MEDICAL CENTER
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 1, 1965 in IL
- Enrollment address
- 1401 E 12TH St
Mendota, IL 61342-9216
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Patricia a Brazeau |
Corporate Officer | Oct 1, 2006 | |
| Corporate Director |
Oct 1, 2006 | ||
| Dawn C Trompeter |
W-2 Managing Employee |
Jan 29, 2018 | |
| Operational/Managerial Control | Dec 21, 2014 | ||
| Anne M Ziegler |
Corporate Director |
Jan 1, 2021 | |
| Melanie R Mann |
Corporate Officer | Oct 6, 2024 | |
| Corporate Director |
Oct 1, 2006 | ||
| Gerald J McShane |
Corporate Director |
Sep 1, 1996 | |
| Osf Healthcare Ministries |
Operational/Managerial Control | Nov 1, 2024 | |
| Kathleen F Williams |
Corporate Officer |
Nov 1, 2014 | |
| Corporate Director |
Jan 1, 2003 | ||
| Kirsten M Largent |
Contracted Managing Employee |
Nov 8, 2024 | |
| Corporate Officer |
Nov 8, 2024 | ||
| Operational/Managerial Control |
Nov 8, 2024 | ||
| Osf Healthcare System |
Operational/Managerial Control | Apr 1, 2015 | |
| Michelle D Conger |
Corporate Officer | Jan 1, 2025 | |
| Corporate Director |
Jan 1, 2025 | ||
| Operational/Managerial Control |
Jan 1, 2025 | ||
| Judith a Duvall |
Corporate Officer | Oct 1, 2006 | |
| Corporate Director |
Oct 1, 1989 | ||
| Brian J Silverstein |
Corporate Director |
Jan 27, 2014 | |
| Paula K Selamat |
Corporate Director |
Oct 6, 2024 | |
| Bridget J Meidl |
Corporate Officer | Apr 4, 2026 | |
| Corporate Director |
Nov 1, 2014 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080124000259 | IL | Part a Provider - Critical Access Hospital | 2264335777 | Practice locations: Mendota, IL |
National Provider Directory
- Part of
- Eastland Med Plaza Surg
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | 275N00000X | IL | Yes |
Addresses
Primary practice location
1401 East 12TH Street
Mendota, IL 61342-9216
Mailing address
124 SW Adams St
Peoria, IL 61602-1308
Phone (093) 655-2850
Other names
- OSF Saint Paul Medical Center
- OSF HealthCare Saint Paul Medical Center
Other providers in Mendota, IL
- Mendota Community Hospital
- Mendota Community Hospital
- Mendota Community Hospital
- Mendota Community Hospital
- Mendota Community Hospital
- Mendota Community Hospital
- Mendota Community Hospital
- Mendota TWP H S Dist 280
- Michael P. Vercimak MDSC
- Tamara Marie Morris
All providers in Mendota, IL · Medicare Defined Swing Bed Hospital Unit in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 2, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.