Memorial Home Services
Organization Active NPI Community Based Hospice Care Agency · Springfield, IL
NPI 1003935560 · NPPES record last updated Aug 5, 2019
Key facts
- NPI
- 1003935560
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- License
- 2000719 (IL)
- Legal business name
- MEMORIAL HOME SERVICES
- Practice address
- 701 N 1St St
Springfield, IL 62781-4952 - Phone
- (217) 788-4663
- NPI assigned
- Mar 28, 2007
- Organization subpart
- No
Authorized official
- Name
- Alexis Walch
- Title
- Director- Hospice
- Phone
- (217) 788-4663
Owners & managing parties with NPI records 2
-
Ted Robert Clark, M.D., M.P.P.
-
Muhammad N Khan, MD
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 1
Member organizations 5
Affiliated clinicians 51
-
Philip James Abraham, M.D.
-
Bryan J. Albracht, D.O.
-
Hima S Atluri, MD
-
Solmaz Bauk, M.D.
-
Alison E Bilyeu, MD
-
Joe A Bilyeu, M.D.
-
Vicki L. Browder, D.O.
-
Dennis M Carroll, M.D.
-
Ha Young Cho, MD
-
Michael Vail Comerford, M.D.
-
Dean Ryan Davis, MD
-
Richard K Delvalle, M.D.
-
Pavinderpal S. Gill, M.D.
-
Perry P Guaglianone, M.D.
-
Kaitlin Delaney Henry, M.D.
-
Naeemuddin Jatoi, M.D.
-
Muhammad N Khan, MD
-
Kevin S Londe, DO
-
Lauri F Lopp, MD
-
Christopher Martinek, M.D.
Medicare Care Compare: Hospice
- Listed as
- Hospice Care of Illinois
- Ownership
- Other
- Certified
- Oct 19, 1990
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Hospice certification: CCN 141540
- Legal name
- MEMORIAL HOME SERVICES
- Doing business as
- MEMORIAL HOME HOSPICE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Oct 19, 1990
- Last certification
- Aug 13, 2021
- Ownership / control type
- Other
- Organization structure
- Corporation · Non-profit
- Incorporated
- Feb 2, 1916 in IL
- Enrollment address
- 701 North First Street
Mailbox 15
Springfield, IL 62781
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Tamar Kutz |
Corporate Director |
Feb 1, 2018 | |
| Jameson Roszhart |
Corporate Director |
Feb 1, 2015 | |
| Michael T Huffman |
Corporate Director |
Jan 1, 2024 | |
| Melanie Atwood |
Corporate Officer |
Jan 10, 2020 | |
| W-2 Managing Employee |
Jan 10, 2020 | ||
| Dolan Dalpoas |
Corporate Director |
Jan 1, 2019 | |
| Ted R Clark |
Corporate Director |
Jan 1, 2026 | |
| Kathryn J Keim |
Corporate Director |
Feb 1, 2019 | |
| Muhammad N Khan |
Contracted Managing Employee |
Jan 1, 2026 | |
| Henry Hurwitz |
Corporate Director |
Jan 1, 2024 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Memorial Home Services |
Home health agency | 5% Or Greater Direct Ownership Interest | Jun 13, 1984 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090304000308 | IL | Part a Provider - Hospice | 8527069715 | Practice locations: Decatur, IL; Springfield, IL |
National Provider Directory
Locations
306 N Westgate Ave
Ste B
Jacksonville, IL 62650
Phone (217) 243-3377
701 N 1st St
#15
Springfield, IL 62781
303 E Bidwell St
Taylorville, IL 62568
Phone (217) 824-1134
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 2000719 | IL | Yes |
Addresses
Primary practice location
701 N 1St St
Springfield, IL 62781-4952
Mailing address
701 N 1St St
Springfield, IL 62781-4952
Phone (217) 788-4663
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 009326 | Other | IL | HEALTH ALLIANCE |
| 137487 | Other | IL | HEALTHLINK |
| 9575 | Other | IL | BLUE CROSS BLUE SHIELD |
| L016474 | Other | IL | TRICARE |
Other names
- Memorial Home Hospice
Other providers in Springfield, IL
- Sarah Melton
- Hailey Melvin
- Memorial Expresscare, LLC
- Memorial Health Partners
- Memorial Health Ventures
- Memorial Home Services
- Memorial Home Services of Central Illinois, Inc
- Memorial Medical Center
- Memorial Medical Center
- Memorial Medical Center
All providers in Springfield, IL · Community Based Hospice Care Agency in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 5, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.