NPIMap

Organization Active NPI

Alexian Brothers Behavioral Health Hospital

  • Psychiatric Hospital
  • Hoffman Estates, IL
National Provider Identifier
1013017839
Registry record updated Feb 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL
Practice address
1650 Moon Lake Boulevard
Hoffman Estates, IL 60169
Phone
(800) 432-5005
NPI assigned
Sep 22, 2006
Last updated
Feb 17, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2021

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

Authorized official

Name
Lisa Neuman
Title
Vice President, Budget/Decision Sup
Phone
(847) 590-2555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X NU Primary

Addresses

Primary practice location

1650 Moon Lake Boulevard
Hoffman Estates, IL 60169

Mailing address

1650 Moon Lake Boulevard
Hoffman Estates, IL 60169
Phone (800) 432-5005

Other identifiers 1

IdentifierTypeStateIssuer
402OtherILBLUE CROSS BLUE SHIELD

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.mettles.com/ Other

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040908000182 IL Part B Supplier - Clinic/Group Practice 9537062138 Receives reassigned benefits from 65 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Chicago, IL; Bartlett, IL; Westmont, IL; South Barrington, IL; Schaumburg, IL; Lake Zurich, IL; Hoffman Estates, IL; Crystal Lake, IL
O20100803001119 IL Part A Provider - Hospital 9537062138 Practice locations: Crystal Lake, IL; Elk Grove Village, IL; Hoffman Estates, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013017839. Details of each certification follow.

Hospital certification: CCN 144031

Legal name
ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL
Doing business as
ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jun 28, 1990
Last certification
Aug 25, 2010
Beds
136
Ownership / control type
Church
Most recent change of ownership
Feb 19, 1998 (1 total)
Organization structure
CorporationNon-profit
Enrollment address
1650 Moon Lake Blvd
Hoffman Estates, IL 60169-1010
Other Hospital Practice Location
Hospital subgroups
Psychiatric

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Alexian Brothers Behavioral HLTH HospCCN 144031 · All quality measures
Type
Psychiatric
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0913392Alexian Brothers Behavioral Health Hospital1650 Moon Lake Blvd, Hoffman Estates, IL 60169Certificate of waiverMar 28, 2028

National Provider Directory

National Provider Directory

Networks

  • IL HMO C-SNP

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/380/brand/6/csg/181/fhir/r4
  • FHIR API: https://epicmobile.presencehealth.org/fhirPRD/api/FHIR/R4/
  • FHIR API: https://fhir-myrecord.cerner.com/r4/aa9a3bec-4c8c-4fc5-b283-495def30e623/

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Clayton Ciha Individual Corporate OfficerPresident/Ceo Jul 1, 2011
Deborah Mau Individual Corporate OfficerCfo May 3, 2020
W-2 Managing Employee May 3, 2020
Alexian Brothers Health System Organization, Chicago, IL Non-profit, Chain home office Operational/Managerial Control Aug 3, 2010
Legary N Vaselopulos Individual Corporate DirectorDirector, Reimbursement Dec 9, 2018
W-2 Managing EmployeeDirector, Reimbursement Dec 9, 2018
Ascension Health Organization, Saint Louis, MO Non-profit Operational/Managerial Control Apr 1, 2022
Polly Davenport Individual Corporate OfficerCeo Apr 1, 2022

Facilities with the same owner 157

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 157

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613520000000",
    "number": "1013017839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1650 MOON LAKE BOULEVARD",
            "city": "HOFFMAN ESTATES",
            "state": "IL",
            "postal_code": "60169",
            "telephone_number": "800-432-5005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 MOON LAKE BOULEVARD",
            "city": "HOFFMAN ESTATES",
            "state": "IL",
            "postal_code": "60169",
            "telephone_number": "800-432-5005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALEXIAN BROTHERS BEHAVIORAL HEALTH HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "status": "A",
        "authorized_official_last_name": "NEUMAN",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "VICE PRESIDENT, BUDGET/DECISION SUP",
        "authorized_official_telephone_number": "847-590-2555"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "402",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.mettles.com/",
            "affiliation": "N",
            "endpointDescription": "2.16.840.1.113883.3.6037.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "10320 Little Patuxent Pkwy Ste 233-02",
            "city": "Columbia",
            "state": "MD",
            "country_code": "US",
            "postal_code": "210443313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Hoffman Estates, IL

Sources for this page

Verify at the official NPI Registry.