When ranking integrated health systems by the total number of facilities they own or manage, there’s a new No. 1: St. Louis, Mo.-based Ascension Health.

According to the report released by SK&A, Ascension now controls 2,331 total facilities, up from nearly over 2,100 in 2016. That was enough to overtake Community Health Systems for the No. 1 spot, with CHS’ ongoing downsizing bringing its total to 1,930 facilities from 2,224 last year.

“The new ecosystem of healthcare is maturing rapidly,” the SK&A report said “The integrated customer is moving from uncoordinated to advanced levels of influence, control and financial responsibility. The ranking of the top 25 integrated healthcare systems changes continuously as systems expand their networks and range through provider employment, affiliations and management contracts.”

Other systems could be considered the largest by different measures. Nashville-based HCA controls the most hospitals at (192), while Kaiser Permanente is No. 1 by number of physicians (9,632 MDs and DOs combined) and Livonia, Mich.-based Trinity Health has the most nursing homes (43). Ascension, however, is one of only two systems to be in the top five in all of those areas, the other being Catholic Health Initiatives.

Here’s the full top 25 list of largest integrated health systems:

1. Ascension Health (St. Louis)—2,331 total facilities
2. Community Health Systems (Franklin, Tenn.)—1,930
3. Catholic Health Initiatives (Englewood, Colo.)—1,740
4. HCA (Nashville)—1,688
5. Trinity Health (Livonia, Mich.)—1,592
6. Kaiser Permanente (Oakland)—1,204
7. Tenet Healthcare (Dallas)—1,186
8. UPMC Health System (Pittsburgh)—1,010
9. UC Health System (Oakland)—929
10. Carolinas Healthcare System (Charlotte)—817
11. Mercy Health System (Chesterfield, Mo.)—815
12. Partners Healthcare System (Boston)—810
13. New York-Presbyterian Healthcare (New York City)—728
14. Sutter Health (Sacramento, Calif.)—700
15. Northwell Health (Great Neck, N.Y.)—692
16. Baylor Scott & White Health (Dallas)—677
17. LifePoint Health (Brentwood, Tenn.)—672
18. Adventist Health System (Altamonte Springs, Fla.)—620
19. Providence Health & Services (Renton, Wash.)—594
20. Dignity Health (San Francisco)—594
21. Cleveland Clinic—573
22. Universal Health Services (King of Prussia, Pa.)—570
23. Advocate Health Care (Downers Grove, Ill.)—539
24. University of Texas Health System (Austin, Texas)—532
25. University of Indiana Health (Indianapolis, Ind.)—502