NPIMap

Organization Active NPI

Gibson Community Hospital Association

Doing business as The Paxton Clinic

  • Rural Health Clinic/Center
  • Paxton, IL
National Provider Identifier
1992700595
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GIBSON COMMUNITY HOSPITAL ASSOCIATION
Doing business as
The Paxton Clinic
Practice address
227 N Market St
Paxton, IL 60957-1123
Phone
(217) 379-4864
Fax
(217) 379-6494
NPI assigned
Jun 20, 2005
Last updated
Jul 21, 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 21, 2022

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

Authorized official

Name
Matthew Ertel
Title
Chief Financial Officer
Phone
(217) 784-2601

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 006 IL
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

227 N Market St
Paxton, IL 60957-1123

Mailing address

227 N Market St
Paxton, IL 60957-1123
Phone (217) 379-4864

Other names 1

  • The Paxton Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL3 enrollments

Enrollment records 3

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…
O20100831000621 IL Part A Provider - Rural Health Clinic 5092703124 Practice locations: Paxton, IL
O20120531000599 IL DME Supplier - Multi-Specialty - Physician 5092703124 Practice locations: Paxton, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992700595. Details of each certification follow.

Rural health clinic certification: CCN 143408

Legal name
GIBSON COMMUNITY HOSPITAL ASSOCIATION
Doing business as
THE PAXTON CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 4, 1995
Last certification
Jul 18, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Nov 30, 1946 in IL
Enrollment address
227 N Market St
Paxton, IL 60957-1123
Related CCNs
141317

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

View all 23

Other NPIs with the same Medicare PAC ID 15

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

View all 15

Other NPIs on the same Medicare enrollment 38

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

View all 38

National Provider Directory

National Provider Directory
Part of
Gibson Area Hospital

Ownership & related parties

All disclosed owners & managing parties 19

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 100%
Joshua a Johnson Individual W-2 Managing EmployeeDirector of PFS Dec 13, 2016
Michael E Young Individual Corporate DirectorBoard Member Nov 1, 2001
Ellen M Lee Individual Corporate DirectorBoard Vice President Nov 1, 1990
Justin Taylor Individual Corporate DirectorBoard Member Mar 1, 2018
Nancy L Krumwiede Individual Corporate DirectorBoard Secretary Nov 1, 1999
Grant W Kummerow Individual W-2 Managing EmployeeManaged Care Coordinator Jan 8, 2018
Kevin D Seymour Individual Corporate DirectorBoard Member Mar 1, 2018
Carl E Hudson Individual Corporate DirectorBoard Member Nov 1, 1988
David J Hagan Individual Corporate DirectorBoard Member Nov 1, 1985
Kathleen J Bennett Individual Corporate DirectorBoard Member Nov 1, 2010
Matthew R Ertel Individual Corporate OfficerCfo Oct 1, 2016
W-2 Managing EmployeeCfo Oct 1, 2016
Robin L Rose Individual Corporate OfficerCoo/Cno Nov 15, 2004
W-2 Managing EmployeeCoo/Cno Nov 15, 2004
Marty a Nuss Individual Corporate DirectorBoard President Nov 1, 2010
Steven P Kelly Individual Corporate DirectorBoard Member Nov 1, 2009
Darrin M Ray Individual Corporate DirectorBoard Member Nov 16, 2016
Brian E Steidinger Individual Corporate DirectorBoard Member Nov 16, 2016
Mike E Petersen Individual Corporate DirectorBoard Member Mar 1, 2018
Margo C Martin Individual Corporate DirectorBoard Member 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 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1119225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1992700595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "227 N MARKET ST",
            "city": "PAXTON",
            "state": "IL",
            "postal_code": "609571123",
            "telephone_number": "217-379-4864",
            "fax_number": "217-379-6494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "227 N MARKET ST",
            "city": "PAXTON",
            "state": "IL",
            "postal_code": "609571123",
            "telephone_number": "217-379-4864",
            "fax_number": "217-379-6494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GIBSON COMMUNITY HOSPITAL ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GIBSON COMMUNITY HOSPITAL ASSOCIATION",
        "enumeration_date": "2005-06-20",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "ERTEL",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "217-784-2601"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "IL",
            "license": "006",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Paxton Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Paxton, IL

Sources for this page

Verify at the official NPI Registry.