NPIMap

Organization Active NPI

Memorial Home Services

  • Community Based Hospice Care Agency
  • Springfield, IL
National Provider Identifier
1003935560
Registry record updated Aug 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
2000719 Issued in 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
Last updated
Aug 5, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2019

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

Authorized official

Name
Alexis Walch
Title
Director- Hospice
Phone
(217) 788-4663

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 2000719 IL Primary

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 names 1

  • Memorial Home Hospice Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090304000308 IL Part A Provider - Hospice 8527069715 Practice locations: Decatur, IL; Springfield, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003935560. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Feb 2, 1916 in IL
Enrollment address
701 North First Street
Mailbox 15
Springfield, IL 62781

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Hospice Care of IllinoisCCN 141540 · All quality measures
Ownership
Other
Certified
Oct 19, 1990
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Member organizations 5

Organizations listed as members of this organization in the 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

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Tamar Kutz Individual Corporate DirectorBoard Member Feb 1, 2018
Jameson Roszhart Individual Corporate DirectorBoard Member Feb 1, 2015
Michael T Huffman Individual Corporate DirectorBoard Member Jan 1, 2024
Melanie Atwood Individual Corporate OfficerSystem Director, Home Hospice Jan 10, 2020
W-2 Managing EmployeeAd; Jan 10, 2020
Dolan Dalpoas Individual Corporate DirectorBoard Member Jan 1, 2019
Ted R Clark Individual Corporate DirectorBoard Member Jan 1, 2026
Kathryn J Keim Individual Corporate DirectorBoard Member Feb 1, 2019
Muhammad N Khan Individual Contracted Managing EmployeeMD; Jan 1, 2026
Henry Hurwitz Individual Corporate DirectorBoard Member Jan 1, 2024

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Memorial Home ServicesSpringfield, IL, CCN 147003 Home health agency 5% Or Greater Direct Ownership Interest Jun 13, 1984

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 51

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 51

NPI Registry JSON

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564963200000",
    "number": "1003935560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 N 1ST ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627814952",
            "telephone_number": "217-788-4663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 N 1ST ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627814952",
            "telephone_number": "217-788-4663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HOME SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-28",
        "last_updated": "2019-08-05",
        "status": "A",
        "authorized_official_last_name": "WALCH",
        "authorized_official_first_name": "ALEXIS",
        "authorized_official_title_or_position": "DIRECTOR- HOSPICE",
        "authorized_official_telephone_number": "217-788-4663"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "IL",
            "license": "2000719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Home Hospice",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.