NPIMap

Organization Active NPI

Gibson Community Hospital Association

Doing business as Gibson Area Hospital ENT Clinic

  • Otolaryngology Physician
  • Gibson City, IL
National Provider Identifier
1982343448
Registry record updated Jul 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
GIBSON COMMUNITY HOSPITAL ASSOCIATION
Doing business as
Gibson Area Hospital ENT Clinic
Practice address
1 Doctors Park
Gibson City, IL 60936
Phone
(217) 784-2808
Fax
(217) 680-0008
NPI assigned
Jun 2, 2022
Last updated
Jul 7, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
GIBSON COMMUNITY HOSPITAL ASSOCIATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 7, 2022

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

Authorized official

Name
Matthew Ertel
Title
Cfo
Phone
(217) 784-2601

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X NU Primary

Addresses

Primary practice location

1 Doctors Park
Gibson City, IL 60936

Mailing address

1120 N Melvin St
Gibson City, IL 60936-1477
Phone (217) 784-4251

Other names 1

  • Gibson Area Hospital ENT Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040505001293 IL Part B Supplier - Clinic/Group Practice 5092703124 Receives reassigned benefits from 201 practitioners
38 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Watseka, IL; Urbana, IL; Paxton, IL; Fairbury, IL; Onarga, IL; Mahomet, IL; Hoopeston, IL; Gibson City, IL…
O20071116000131 IL Part A Provider - Critical Access Hospital 5092703124 Receives reassigned benefits from 156 practitioners
22 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Onarga, IL; Hoopeston, IL; Gibson City, IL; Forrest, IL; Cissna Park, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982343448. Details of each certification follow.

Hospital certification: CCN 141317

Legal name
GIBSON COMMUNITY HOSPITAL ASSOCIATION
Doing business as
GIBSON AREA HOSPITAL & HEALTH SERVICES
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 3, 2002
Last certification
Oct 7, 2016
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Nov 30, 1946 in IL
Enrollment address
1120 N Melvin St
Gibson City, IL 60936-1477

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

Other NPIs on the same Medicare enrollment 43

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

View all 43

Care Compare: Hospital

Medicare Care Compare
Listed as
Gibson Community HospitalCCN 141317 · All quality measures
Overall star rating
4 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Gibson Area Hospital43 organizations share this tax ID, including this one
Part of
Gibson Area Hospital

Other organizations with this tax ID 42

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

View all 42

Locations

501A S Towanda Barnes Rd
Ste 2
Bloomington, IL 61705
Phone (309) 612-9002

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Robert C Schmitt Individual Corporate OfficerCeo Dec 9, 2002
W-2 Managing EmployeeCeo Dec 9, 2002
Jessica Delost Individual Corporate Officer Oct 1, 2022
W-2 Managing Employee Oct 1, 2022
Michael E Young Individual Corporate Director Nov 1, 2001
Ellen M Lee Individual Corporate Director Nov 1, 1990
Mark M Spangler Individual Corporate Director Nov 1, 2022
Justin Taylor Individual Corporate Director Mar 1, 2018
Kevin D Seymour Individual Corporate Director Mar 1, 2018
Kathleen J Bennett Individual Corporate Director Nov 1, 2010
Donald P Reese Individual Corporate Director Feb 1, 2021
Matthew R Ertel Individual Corporate OfficerCfo Oct 1, 2016
W-2 Managing EmployeeCfo Oct 1, 2016
Robin L Rose Individual Corporate OfficerCoo/Cco Nov 15, 2004
W-2 Managing EmployeeCoo/Cco Nov 15, 2004
Andy Hudson Individual Corporate Officer Nov 1, 2022
Marty a Nuss Individual Corporate Director Nov 1, 2010
Steven P Kelly Individual Corporate Director Nov 1, 2009
Brian E Steidinger Individual Corporate Director Nov 16, 2016
Justin Swan Individual Corporate Director Oct 1, 2022
Mike E Petersen Individual Corporate Director Mar 1, 2018
Margo C Martin Individual Corporate Director Nov 1, 1999

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 25

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 25

Affiliated clinicians 153

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

View all 153

NPI Registry JSON

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

{
    "created_epoch": "1654128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1657152000000",
    "number": "1982343448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1120 N MELVIN ST",
            "city": "GIBSON CITY",
            "state": "IL",
            "postal_code": "609361477",
            "telephone_number": "217-784-4251",
            "fax_number": "217-784-2645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 DOCTORS PARK",
            "city": "GIBSON CITY",
            "state": "IL",
            "postal_code": "60936",
            "telephone_number": "217-784-2808",
            "fax_number": "217-680-0008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIBSON COMMUNITY HOSPITAL ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GIBSON COMMUNITY HOSPITAL ASSOCIATION",
        "enumeration_date": "2022-06-02",
        "last_updated": "2022-07-07",
        "certification_date": "2022-07-07",
        "status": "A",
        "authorized_official_last_name": "ERTEL",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "217-784-2601"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gibson Area Hospital ENT Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gibson Area Hospital ENT Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gibson City, IL

Sources for this page

Verify at the official NPI Registry.