NPIMap

Organization Active NPI

Mendota Community Hospital

Doing business as OSF Saint Paul Medical Center

  • Critical Access Hospital
  • Mendota, IL
National Provider Identifier
1962537498
Registry record updated Mar 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
0001537 Issued in IL
Legal business name
MENDOTA COMMUNITY HOSPITAL
Doing business as
OSF Saint Paul Medical Center
Practice address
1401 East 12TH Street
Mendota, IL 61342-9216
Phone
(815) 539-7461
Fax
(815) 538-5516
NPI assigned
Feb 23, 2007
Last updated
Mar 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2024

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

Authorized official

Name
Robert C Sehring
Title
Ceo
Phone
(309) 655-2850

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 0001537 IL Primary

Addresses

Primary practice location

1401 East 12TH Street
Mendota, IL 61342-9216

Mailing address

124 SW Adams St
Peoria, IL 61602-1320
Phone (309) 655-2850

Other identifiers 2

IdentifierTypeStateIssuer
000MedicaidIL
05015094OtherILBC 1500 BILLING NUMBER

Other names 2

  • OSF Saint Paul Medical Center Doing business as
  • OSF Medical Group-Mendota Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040131000102 IL Part B Supplier - Clinic/Group Practice 2264335777 Receives reassigned benefits from 104 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Oglesby, IL; Paw Paw, IL; Peru, IL; Spring Valley, IL; Mendota, IL; Granville, IL

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Mary Chinn MD11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Locations

1405 E 12th St
#700
Mendota, IL 61342
Phone (815) 539-2663

Practitioners & affiliated clinicians

Practitioners 28

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 28

NPI Registry JSON

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710720000000",
    "number": "1962537498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 SW ADAMS ST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616021320",
            "telephone_number": "309-655-2850",
            "fax_number": "309-655-4878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 EAST 12TH STREET",
            "city": "MENDOTA",
            "state": "IL",
            "postal_code": "613429216",
            "telephone_number": "815-539-7461",
            "fax_number": "815-538-5516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MENDOTA COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-23",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A",
        "authorized_official_last_name": "SEHRING",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "309-655-2850"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IL",
            "license": "0001537",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC 1500 BILLING NUMBER",
            "identifier": "05015094",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "OSF Saint Paul Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "OSF Saint Paul Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "OSF Medical Group-Mendota",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mendota, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.