Shawneetown Healthcare Clinic – Federally Qualified Health Center (FQHC), NPI 1285614867

Shawneetown Healthcare Clinic is a healthcare provider. based in Shawneetown, Illinois. specializing in Federally Qualified Health Center (FQHC). The NPI Number for Shawneetown Healthcare Clinic is 1285614867

Main info

Organization
Name
Shawneetown Healthcare Clinic
NPI
1285614867
Phone
(618) 269-3815
Address
9525 GOLD HILL ROAD
Authorized Official
KIMBERLY MITROKA CEO
Enumeration Date
19 January 2006
Last Update Date
30 January 2026
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience65
Completeness90
Years active:20State licenses:0Digital endpoints

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Provider Addresses for Shawneetown Healthcare Clinic

  • 9525, Gold Hill Road, Shawneetown, Gallatin County, Illinois, 62984, United States

    SHAWNEETOWN HEALTH CARE CLINIC

    SHAWNEETOWN, IL 62984

    Phone: (618) 269-3815

    Fax: (618) 269-3274

    Type: Location

  • PO BOX 155

    CHRISTOPHER GREATER AREA RURAL HEALTH PLANNING CORP

    CHRISTOPHER, IL 62822

    Phone: (618) 724-2401

    Fax: (618) 724-2571

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2003-06-06

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Past revalidation due date

Earliest CMS due date was 2026-05-31 (7 days ago).

Enrollment records

1

Earliest due date

2026-05-31

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
O20030606000006OFederally Qualified Health Center (Fqhc)IL2026-05-31

What to do next

  • Verify current status on the CMS Revalidation Lookup Tool immediately.
  • Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
  • Overdue revalidation can lead to deactivation of Medicare billing privileges.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 62984)

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Reviews

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Frequently asked questions

What NPI should I save for Shawneetown Healthcare Clinic?
Save NPI 1285614867 if you need a stable reference for Shawneetown Healthcare Clinic.
Is Shawneetown Healthcare Clinic currently active in the NPI registry?
CMS-published data lists Shawneetown Healthcare Clinic as an active registrant.
What kind of provider is Shawneetown Healthcare Clinic?
The page reflects Federally Qualified Health Center (FQHC) for Shawneetown Healthcare Clinic. Clinical services aligned with this taxonomy classification.
What location shows for Shawneetown Healthcare Clinic?
We surface Shawneetown, Illinois for Shawneetown Healthcare Clinic based on available NPPES addresses.
Is Shawneetown Healthcare Clinic a real provider?
This page reflects official NPPES data for NPI 1285614867. Always confirm identity and privileges with the practice and licensing boards.

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