NPIMap

Organization Active NPI

Protestant Memorial Medical Center, Inc.

Doing business as Memorial Hospital

  • General Acute Care Hospital
  • Belleville, IL
National Provider Identifier
1982796181
Registry record updated Jul 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
0001461 Issued in IL
Legal business name
PROTESTANT MEMORIAL MEDICAL CENTER, INC.
Doing business as
Memorial Hospital
Practice address
4500 Memorial Dr
Belleville, IL 62226-5360
Phone
(618) 233-7750
NPI assigned
Sep 28, 2006
Last updated
Jul 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2024

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

Authorized official

Name
Ms. Jane Gusmano
Title
Vice President
Phone
(618) 257-5607

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 0001461 IL Primary

Addresses

Primary practice location

4500 Memorial Dr
Belleville, IL 62226-5360

Mailing address

4500 Memorial Dr
Belleville, IL 62226-5360
Phone (618) 233-7750

Other practice location 1

1418 Cross St Ste 180
Shiloh, IL 62269-2965
Phone (618) 607-1419

Other names 1

  • MEMORIAL HOSPITAL Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071201000027 IL Part A Provider - Hospital 2961461314 Practice locations: Alton, IL; Belleville, IL; Columbia, IL; Edwardsville, IL; Shiloh, IL; O Fallon, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982796181. Details of each certification follow.

Hospital certification: CCN 140185

Legal name
PROTESTANT MEMORIAL MEDICAL CENTER, INC.
Doing business as
MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Apr 21, 2016
Beds
341
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
4500 Memorial Dr
Belleville, IL 62226-5360
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Memorial HospitalCCN 140185 · All quality measures
Overall star rating
5 of 5
Type
Acute Care 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
Memorial Hosp Eeg5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

4500 Memorial Dr
Ofc 1ST
Belleville, IL 62226

Ownership & related parties

All disclosed owners & managing parties 22

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

NameRoleSinceShare
Kurtis S Schroeder Individual Corporate DirectorBoard Member Jan 1, 2021
Operational/Managerial ControlBoard Member Jan 1, 2021
Rebecca Olroyd Individual Corporate DirectorBoard Member Jan 1, 2025
Rachel Jackson Individual Corporate DirectorBoard Member Jan 1, 2019
Operational/Managerial Control Jan 1, 2019
Michele McKee Individual Corporate OfficerVice President, Finance Jan 1, 2026
Operational/Managerial ControlVice President, Finance Jan 1, 2026
Hans H Moosa Individual Corporate DirectorBoard Member Jan 1, 2021
Operational/Managerial ControlBoard Member Jan 1, 2021
Valerie L Thaxton Individual Corporate OfficerChairman Jan 1, 2021
Corporate DirectorBoard Member Jan 1, 2021
Operational/Managerial ControlBoard Member Jan 1, 2021
Randolph Ganim Individual Corporate DirectorBoard Member Jan 1, 2023
Operational/Managerial ControlBoard Member Jan 1, 2023
Ronald Stephens Individual Corporate DirectorBoard Member Jan 1, 2020
Operational/Managerial ControlBoard Member Jan 1, 2020
Beatriz C Pardo Individual Corporate DirectorBoard Member Jan 1, 2017
Shelley Perulfi Individual Corporate OfficerVice President, Nursing Jan 12, 2025
W-2 Managing EmployeeVice President, Nursing Jan 12, 2025
Operational/Managerial ControlVice President, Nursing Jan 12, 2025
BJC Health System Organization, Saint Louis, MO Corporation, Non-profit Operational/Managerial Control Jan 1, 2018
Kevin a Journagan Individual Corporate OfficerChief Medical Officer Sep 16, 2024
W-2 Managing EmployeeChief Medical Officer Sep 16, 2024
Edward Hoering Individual Corporate OfficerChairman Jan 1, 2016
Corporate DirectorBoard Member Oct 29, 2007
Chris a Eckert Individual Corporate Officer1St Vice Chair Jan 1, 2021
Corporate DirectorBoard Member Jan 1, 2021
Operational/Managerial ControlBoard Member Jan 1, 2021
Deborah K Graves Individual Corporate OfficerPresident Mar 25, 2024
Corporate DirectorPresident Mar 25, 2024
W-2 Managing EmployeePresident Mar 25, 2024
Operational/Managerial ControlPresident Mar 25, 2024
Jeffrey Dossett Individual Corporate OfficerVP, Operations Jun 23, 2020
W-2 Managing EmployeeVP, Operations Jun 23, 2020
Operational/Managerial ControlVP, Operations Jun 23, 2020
Scott Hawig Individual Corporate OfficerVice President, Finance Jan 1, 2026
Operational/Managerial ControlVice President, Finance Jan 1, 2026
Staci Oliver Individual Corporate DirectorBoard Member Jan 1, 2021
Operational/Managerial ControlBoard Member Jan 1, 2021
Geri Boyer Individual Corporate Officer2ND Vice Chair Jan 1, 2020
Corporate DirectorBoard Member Jan 1, 2017
Operational/Managerial ControlBoard Member Jan 1, 2017
Teresa Halloran Individual Corporate OfficerVP, Chief Nurse Executive Nov 14, 2016
W-2 Managing EmployeeVP, Chief Nurse Executive Nov 14, 2016
Operational/Managerial ControlVP, Chief Nurse Executive Nov 14, 2016
Rob Dyer Individual Corporate OfficerChairman Jan 1, 2016
Corporate DirectorBoard Member Jul 30, 2013
Operational/Managerial Control Jul 30, 2013
Keith Cook Individual Corporate DirectorBoard Member Jan 1, 2021
Operational/Managerial ControlBoard Member Jan 1, 2021

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Memorial Care CenterBelleville, IL, CCN 145102 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Feb 17, 2010
Feb 17, 2010

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 32

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

View all 32

Practitioners & affiliated clinicians

Practitioners 5

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.

Affiliated clinicians 1,149

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

View all 1,149

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721001600000",
    "number": "1982796181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 MEMORIAL DR",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265360",
            "telephone_number": "618-233-7750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4500 MEMORIAL DR",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622265360",
            "telephone_number": "618-233-7750"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1418 Cross St Ste 180",
            "address_purpose": "LOCATION",
            "city": "Shiloh",
            "state": "IL",
            "postal_code": "622692965",
            "country_code": "US",
            "telephone_number": "618-607-1419",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROTESTANT MEMORIAL MEDICAL CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2024-07-15",
        "certification_date": "2024-07-15",
        "status": "A",
        "authorized_official_last_name": "GUSMANO",
        "authorized_official_first_name": "JANE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "618-257-5607",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "IL",
            "license": "0001461",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "N",
            "endpointDescription": "BJC",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "4500 Memorial Dr",
            "city": "Belleville",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622265360",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "MEMORIAL HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MEMORIAL HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Belleville, IL

Sources for this page

Verify at the official NPI Registry.