NPIMap

Organization Active NPI

McDonough County Hospital District

Doing business as Bushnell Family Practice

  • Rural Health Clinic/Center
  • Bushnell, IL
National Provider Identifier
1992041511
Registry record updated Feb 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MCDONOUGH COUNTY HOSPITAL DISTRICT
Doing business as
Bushnell Family Practice
Practice address
1150 N Cole St
Bushnell, IL 61422-9503
Phone
(309) 772-9444
Fax
(309) 772-9446
NPI assigned
Dec 31, 2012
Last updated
Feb 20, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2025

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

Authorized official

Name
Mr. Bill W Murdock
Title
Ceo
Phone
(309) 833-4101

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Family Medicine Physician 207Q00000X IL

Addresses

Primary practice location

1150 N Cole St
Bushnell, IL 61422-9503

Mailing address

525 E Grant St
Suite 302
Macomb, IL 61455-3313

Other identifiers 3

IdentifierTypeStateIssuer
148952OtherILMEDICARE - RURAL HEALTH
5515957OtherILBLUE CROSS BLUE SHIELD OF ILLINOIS
036062336MedicaidIL

Other names 1

  • Bushnell Family Practice Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130326000624 IL Part A Provider - Rural Health Clinic 0446140180 Practice locations: Bushnell, IL
O20131115000755 IL Part B Supplier - Clinic/Group Practice 0446140180 Receives reassigned benefits from 15 practitioners
Practice locations: Bushnell, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992041511. Details of each certification follow.

Rural health clinic certification: CCN 148522

Legal name
MCDONOUGH COUNTY HOSPITAL DISTRICT
Doing business as
BUSHNELL FAMILY PRACTICE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 31, 2013
Last certification
Feb 18, 2022
Ownership / control type
2B
Organization structure
OtherNon-profit
Incorporated
Mar 16, 1955 in IL
Enrollment address
1150N Cole St
Bushnell, IL 61422-9503
Related CCNs
140089

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

Other NPIs with the same Medicare PAC ID 10

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0431302Bushnell Family Practice1150 N Cole, Bushnell, IL 61422Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
McDonough County Hospital20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

Locations

525 E Grant St
Ste 302
Macomb, IL 61455

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
McDonough County Hospital District Organization, Macomb, IL 5% Or Greater Direct Ownership Interest Feb 1, 2013 100%
Sherri L Hitchcock Individual Corporate OfficerCfo Feb 1, 2025
W-2 Managing EmployeeCfo Feb 1, 2025
William R Murdock Individual Corporate OfficerPresident & Ceo Apr 22, 2019
W-2 Managing EmployeePresident & Ceo Apr 22, 2019

Owners & managing parties with NPI records 10

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

All facility ownership & control disclosures 6

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

FacilityTypeRoleSince
McDonough District HospitalMacomb, IL, CCN 140089 Hospital 5% Or Greater Direct Ownership Interest (100%) Sep 30, 2018
McDonough District HospitalMacomb, IL, CCN 14U089 Hospital 5% Or Greater Direct Ownership Interest (100%) Jun 10, 2014
McDonough District Hospital Home HealthMacomb, IL, CCN 147293 Home health agency Operational/Managerial Control (100%) Oct 22, 2012
McDonough District HospitalMacomb, IL, CCN 141524 Hospice 5% Or Greater Direct Ownership Interest (100%) Jan 12, 1989
MDH Family Medicine/Convenience Care/Surgery/ENT ClinicMacomb, IL, CCN 148619 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2020
MDH Pediatric ClinicMacomb, IL, CCN 148617 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2020

Owned or controlled facilities with NPI records 6

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

Facilities with the same owner 6

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

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1356912000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740009600000",
    "number": "1992041511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 E GRANT ST",
            "address_2": "SUITE 302",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614553313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 N COLE ST",
            "city": "BUSHNELL",
            "state": "IL",
            "postal_code": "614229503",
            "telephone_number": "309-772-9444",
            "fax_number": "309-772-9446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCDONOUGH COUNTY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-31",
        "last_updated": "2025-02-20",
        "certification_date": "2025-02-20",
        "status": "A",
        "authorized_official_last_name": "MURDOCK",
        "authorized_official_first_name": "BILL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "309-833-4101",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE - RURAL HEALTH",
            "identifier": "148952",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF ILLINOIS",
            "identifier": "5515957",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036062336",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bushnell Family Practice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bushnell Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bushnell, IL

Sources for this page

Verify at the official NPI Registry.