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Southern Illinois Medical Services, NFP

Organization Active NPI Rural Health Clinic/Center · Murphysboro, IL

NPI 1992032809 · NPPES record last updated Jan 7, 2025

Key facts

NPI
1992032809
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
SOUTHERN ILLINOIS MEDICAL SERVICES, NFP
Practice address
19 E Shawnee Dr
Suite 2
Murphysboro, IL 62966-7071
Phone
(618) 684-2172
Fax
(618) 687-4480
NPI assigned
Nov 13, 2009
Organization subpart
Yes
Parent organization (as reported)
SOUTHERN ILLINOIS HOSPITAL SERVICES

Authorized official

Name
Warren P Ladner
Title
Senior VP Chief Financial Officer
Phone
(618) 457-5200

Owners & managing parties with NPI records 6

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

Other NPIs with the same Medicare PAC ID 7

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

Corporate family (same tax ID) 6

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Facilities with the same owner 16

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

Practitioners 331

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 331

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IL

Rural health clinic certification: CCN 143871

Legal name
SOUTHERN ILLINOIS MEDICAL SERVICES NFP
Doing business as
MEDICAL ARTS CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 12, 1994
Last certification
Nov 7, 2018
Ownership / control type
2B
Most recent change of ownership
Nov 1, 2009 (1 total)
Organization structure
Corporation · Non-profit
Incorporated
Aug 30, 2006 in IL
Enrollment address
19 E Shawnee Drive
Suite 2
Murphysboro, IL 62966-7049

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Morton P Levine
Individual 		Corporate Director
Board Member		 Jun 27, 2013
Robert L Mees
Individual 		Corporate Officer
Chair		 Jun 28, 2012
Kathleen B Fralish
Individual 		Corporate Director
Board Member		 Nov 13, 2006
Southern Illinois Healthcare Enterprises Inc
Organization · Carbondale, IL
Non-profit 		5% Or Greater Indirect Ownership Interest Nov 1, 2009 100%
Southern Illinois Hospital Services
Organization · Carbondale, IL
Non-profit 		5% Or Greater Direct Ownership Interest Nov 1, 2009 100%
Operational/Managerial Control Nov 1, 2009 100%
Warren P Ladner
Individual 		Corporate Officer
Cfo		 Feb 21, 2022
Operational/Managerial Control
Cfo		 Feb 21, 2022
George M O'Neill
Individual 		Corporate Director
Board Member		 Nov 13, 2006
Debra L Braunling-McMorrow
Individual 		Corporate Officer
Vice Chair		 Sep 22, 2011
Daniel Booth
Individual 		Corporate Director
Board Member		 Mar 26, 2022
W E Basanta
Individual 		Corporate Director
Board Member		 Jan 26, 1995
Gina Sirach
Individual 		Corporate Director
Board Member		 Mar 24, 2022
Brad Cole
Individual 		Corporate Director
Board Member		 May 3, 2007
Michael P Tison
Individual 		Corporate Director
Board Member		 Jul 22, 2021
Austin a Lane
Individual 		Corporate Director
Board Member		 May 6, 2021
Steven R Sabens
Individual 		Corporate Director
Board Member		 Mar 24, 2011
John D Antes
Individual 		Corporate Officer
Ceo		 Dec 12, 2022

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20101004001310 IL Part a Provider - Rural Health Clinic 3678677390 Practice locations: Murphysboro, IL

National Provider Directory

Tax ID family
Benton Community Healthcare (7 organizations share this tax ID)
Part of
Southern Il Hospital SVCS

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Yes

Addresses

Primary practice location

19 E Shawnee Dr
Suite 2
Murphysboro, IL 62966-7071

Mailing address

PO Box 3988
Carbondale, IL 62902-3988
Phone (618) 457-5200

Other names

  • Medical Arts Clinic Doing business as

Other providers in Murphysboro, IL

All providers in Murphysboro, IL · Rural Health Clinic/Center in Illinois

Sources for this page

Verify at the official NPI Registry.