Adventist Bolingbrook Hospital

Primary specialty

Psychiatric Hospital UnitTaxonomy code 273R00000X

License

5496 Issued in IL

Legal business name

ADVENTIST BOLINGBROOK HOSPITAL

Doing business as

Adventhealth Bolingbrook
Uchicago Medicine Adventhealth Bolingbrook

Practice address

500 Remington Blvd
Bolingbrook, IL 60440-4906

Phone

(630) 312-5000

NPI assigned

Dec 30, 2015

Last updated

Jan 17, 2024By the provider in NPPES

Organization subpart

Yes

Parent organization

ADVENTIST BOLINGBROOK HOSPITALAs reported in NPPES

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

Authorized official

Name

Tristan Shaw

Title

Cfo

Phone

(708) 245-2211

Specialties & licenses 1

Addresses

Other names 2

• ADVENTHEALTH BOLINGBROOK Doing business as
• UCHICAGO MEDICINE ADVENTHEALTH BOLINGBROOK Doing business as

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013372440. Details of each certification follow.

• CCN 14S304 Hospital · Details

Hospital certification: CCN 14S304

Legal name

ADVENTIST BOLINGBROOK HOSPITAL

Doing business as

UCHICAGO MEDICINE ADVENTHEALTH BOLINGBROOK

Organization structure

CorporationNon-profit

Incorporated

Nov 25, 2003 in IL

Enrollment address

500 Remington Blvd
Bolingbrook, IL 60440-4906
Hospital Psychiatric Unit

Hospital subgroups

Psychiatric

Related certifications (CCN) 1

Facilities connected through Provider of Services related, parent or unit certification numbers.

• Adventist Bolingbrook Hospital

  dba Adventhealth Bolingbrook

  • General Acute Care Hospital
  • Bolingbrook, IL
  • NPI 1164530465

  Unit of hospital

  Provider of Services

Other NPIs with the same Medicare PAC ID 2

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

• Adventist Bolingbrook Hospital

  dba Adventhealth Bolingbrook

  • General Acute Care Hospital
  • Bolingbrook, IL
  • NPI 1164530465

  1456449396

  Same PAC ID
• Adventist Bolingbrook Hospital

  dba Adventhealth Bolingbrook

  • Cardiovascular Disease Physician
  • Bolingbrook, IL
  • NPI 1477790160

  1456449396

  Same PAC ID

Tax ID family

Adventist Bolingbrook Hosp8 organizations share this tax ID, including this one

Part of

Adventist Bolingbrook Hosp

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

• Adventist Bolingbrook Hospital

  dba Adventhealth Bolingbrook

  • General Acute Care Hospital
  • Bolingbrook, IL
  • NPI 1164530465
  NPD tax ID
• Adventist Bolingbrook Hospital

  dba UChicago Medicine AdventHealth Pharmacy Bolingbrook

  • Community/Retail Pharmacy
  • Bolingbrook, IL
  • NPI 1184923260
  NPD tax ID
• Adventist Bolingbrook Hospital

  dba Uchicago Medicine Adventhealth Pharmacy Bolingbrook

  • Specialty Pharmacy
  • Bolingbrook, IL
  • NPI 1205120706
  NPD tax ID
• Adventist Bolingbrook Hospital

  dba Uchicago Medicine Adventhealth Pharmacy Bolingbrook

  • Specialty Pharmacy
  • Bolingbrook, IL
  • NPI 1336925817
  NPD tax ID
• Adventist Bolingbrook Hospital

  dba Adventist Bolingbrook Orthopedics

  • Orthopaedic Surgery Physician
  • Bolingbrook, IL
  • NPI 1386015642
  NPD tax ID
• Adventist Bolingbrook Hospital

  dba Adventhealth Bolingbrook

  • Cardiovascular Disease Physician
  • Bolingbrook, IL
  • NPI 1477790160
  NPD tax ID
• Adventist Bolingbrook Hospital

  dba Uchicago Medicine Adventhealth Imaging Plainfield

  • General Acute Care Hospital
  • Plainfield, IL
  • NPI 1578478962
  NPD tax ID

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Adventist Midwest Health

  dba Adventhealth Family Medicine Center Hinsdale

  • Family Medicine Physician
  • Hinsdale, IL
  • NPI 1366579443

  Member Of

  NPD member
• The University of Chicago Medical Center

  dba UCMC Pharmacy Services

  • Home Infusion Therapy Pharmacy
  • Calumet City, IL
  • NPI 1942999073

  Member Of

  NPD member

Locations

All disclosed owners & managing parties 47

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

Owners & managing parties with NPI records 20

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

• Adventist Midwest Health

  • General Acute Care Hospital
  • Hinsdale, IL
  • NPI 1265465439

  5% Or Greater Direct Ownership Interest

  CMS ownership
• Adventist Midwest Health

  dba Adventhealth Hinsdale

  • Psychiatric Hospital Unit
  • Hinsdale, IL
  • NPI 1447270780

  5% Or Greater Direct Ownership Interest

  CMS ownership
• Adventist Midwest Health

  dba Uchicago Medicine Adventhealth Home Care

  • Home Health Agency
  • La Grange, IL
  • NPI 1457397317

  5% Or Greater Direct Ownership Interest

  CMS ownership
• Adventist Midwest Health

  dba Adventist St. Thomas Hospice

  • Community Based Hospice Care Agency
  • Hinsdale, IL
  • NPI 1821020132

  5% Or Greater Direct Ownership Interest

  CMS ownership
• Adventist Midwest Health

  dba Adventhealth Hinsdale

  • Cardiovascular Disease Physician
  • Hinsdale, IL
  • NPI 1962570382

  5% Or Greater Direct Ownership Interest

  CMS ownership
• Aziz Ahmed, M.D.

  • Interventional Cardiology Physician
  • Bloomingdale, IL
  • NPI 1962403998

  Corporate Director

  CMS ownership
• Maninder S. Kohli, M.D.

  • Internal Medicine Physician
  • Hinsdale, IL
  • NPI 1851390348

  Corporate Director

  CMS ownership
• Stacie Levine

  • Geriatric Medicine (Internal Medicine) Physician
  • Chicago, IL
  • NPI 1932261484

  Corporate Director

  CMS ownership
• Nicholas S. Moy, M.D.

  • Hospitalist Physician
  • Bolingbrook, IL
  • NPI 1659537421

  Corporate Director

  CMS ownership
• Aytekin Oto

  • Diagnostic Radiology Physician
  • Chicago, IL
  • NPI 1528142866

  Corporate Director

  CMS ownership
• Sanjay Kirit Patari, MD

  • Orthopaedic Surgery Physician
  • Hoffman Estates, IL
  • NPI 1083662068

  Corporate Director

  CMS ownership
• Arnon E Rubin, MD

  • Pulmonary Disease Physician
  • Westmont, IL
  • NPI 1245217413

  Corporate Director

  CMS ownership

Facilities with the same owner 93

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

• Adventist Bolingbrook Hospital

  dba Adventhealth Bolingbrook

  • General Acute Care Hospital
  • Bolingbrook, IL
  • NPI 1164530465

  Adventist Health System Sunbelt Healthcare Corporation, Adventist Health System Sunbelt Inc, Adventist Midwest Health, The University of Chicago Medical Center

  CMS ownership
• Adventist Glenoaks Hospital

  dba Adventhealth Glenoaks

  • General Acute Care Hospital
  • Glendale Heights, IL
  • NPI 1760415939

  Adventist Health System Sunbelt Healthcare Corporation, Adventist Health System Sunbelt Inc, Adventist Midwest Health, The University of Chicago Medical Center

  CMS ownership
• Adventist Midwest Health

  • General Acute Care Hospital
  • Hinsdale, IL
  • NPI 1265465439

  Adventist Health System Sunbelt Healthcare Corporation, Adventist Health System Sunbelt Inc, Adventist Midwest Health, The University of Chicago Medical Center

  CMS ownership
• Adventist Midwest Health

  dba Adventhealth la Grange

  • General Acute Care Hospital
  • La Grange, IL
  • NPI 1407889652

  Adventist Health System Sunbelt Healthcare Corporation, Adventist Health System Sunbelt Inc, The University of Chicago Medical Center

  CMS ownership
• Adventist Midwest Health

  dba Adventhealth Hinsdale

  • Psychiatric Hospital Unit
  • Hinsdale, IL
  • NPI 1447270780

  Adventist Health System Sunbelt Healthcare Corporation, Adventist Health System Sunbelt Inc, Adventist Midwest Health, The University of Chicago Medical Center

  CMS ownership
• Adventist Midwest Health

  dba Uchicago Medicine Adventhealth Home Care

  • Home Health Agency
  • La Grange, IL
  • NPI 1457397317

  Adventist Health System Sunbelt Healthcare Corporation, Adventist Health System Sunbelt Inc, Adventist Midwest Health, The University of Chicago Medical Center

  CMS ownership
• Adventist Midwest Health

  dba Adventhealth la Grange

  • Rehabilitation Hospital Unit
  • La Grange, IL
  • NPI 1588068274

  Adventist Health System Sunbelt Healthcare Corporation, Adventist Health System Sunbelt Inc, The University of Chicago Medical Center

  CMS ownership
• Adventist Midwest Health

  dba Adventist St. Thomas Hospice

  • Community Based Hospice Care Agency
  • Hinsdale, IL
  • NPI 1821020132

  Adventist Health System Sunbelt Healthcare Corporation, Adventist Health System Sunbelt Inc, Adventist Midwest Health, The University of Chicago Medical Center

  CMS ownership
• Ingalls Memorial Hospital

  • Rehabilitation Hospital Unit
  • Harvey, IL
  • NPI 1023105566

  The University of Chicago Medical Center

  CMS ownership
• Ingalls Memorial Hospital

  • General Acute Care Hospital
  • Harvey, IL
  • NPI 1598756686

  The University of Chicago Medical Center

  CMS ownership
• Ucm Home Care

  dba Ingalls Home Hospice

  • Community Based Hospice Care Agency
  • Harvey, IL
  • NPI 1326083395

  The University of Chicago Medical Center

  CMS ownership
• Ucm Home Care

  • Home Health Agency
  • Harvey, IL
  • NPI 1417998865

  The University of Chicago Medical Center

  CMS ownership

Practitioners 96

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.

• Keenan Adib, MD

  • Cardiovascular Disease Physician
  • Hinsdale, IL
  • NPI 1790098804
  NPD
• Francisco Guillermo Aguilar Jr., MD

  • Clinical Cardiac Electrophysiology Physician
  • Hinsdale, IL
  • NPI 1487637567
  NPD
• Nazia Alvi, D.O.

  • Cardiovascular Disease Physician
  • Hinsdale, IL
  • NPI 1225455900
  NPD
• Edgar S Carell, M.D.

  • Interventional Cardiology Physician
  • Hinsdale, IL
  • NPI 1174578587
  NPD
• Noura M. Dabbouseh, M.D.

  • Cardiovascular Disease Physician
  • Hinsdale, IL
  • NPI 1770882029
  NPD
• Marcin Piotr Dobaczewski, MD, PHD

  • Cardiovascular Disease Physician
  • Hinsdale, IL
  • NPI 1770859993
  NPD
• Duane F Follman, M.D.

  • Interventional Cardiology Physician
  • Hinsdale, IL
  • NPI 1831145333
  NPD
• George Garing Gibbs, M.D.

  • Cardiovascular Disease Physician
  • Hinsdale, IL
  • NPI 1346287927
  NPD
• Peter W Kakavas, M.D.

  • Cardiovascular Disease Physician
  • Palos Park, IL
  • NPI 1528022191
  NPD
• Thomas Theodore Kason, M.D.

  • Cardiovascular Disease Physician
  • Palos Park, IL
  • NPI 1932163037
  NPD
• Daniel E Krauss, M.D.

  • Cardiovascular Disease Physician
  • Hinsdale, IL
  • NPI 1932147154
  NPD
• Vijay Kumar, MD

  • Interventional Cardiology Physician
  • Bloomingdale, IL
  • NPI 1144244146
  NPD

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

{
    "created_epoch": "1451433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705449600000",
    "number": "1013372440",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7009",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604407009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404906",
            "telephone_number": "630-312-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVENTIST BOLINGBROOK HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ADVENTIST BOLINGBROOK HOSPITAL",
        "enumeration_date": "2015-12-30",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "TRISTAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "708-245-2211"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "IL",
            "license": "5496",
            "primary": true
        }
    ],
    "identifiers": [],
    "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"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.13.34.110.1.998.01",
            "affiliationName": "CMS HIH",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "7500 Security Blvd",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212441849",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "ADVENTHEALTH BOLINGBROOK",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ADVENTHEALTH BOLINGBROOK",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UCHICAGO MEDICINE ADVENTHEALTH BOLINGBROOK",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Advanced Patient Care, LLC.
• Advanced Professionals Healthcare, LLC
• Advantage Care Services Inc
• Advantage Surgical Assistants, Inc.
• Advantage Surgical Assisting
• Adventist Bolingbrook Hospital (Adventhealth Bolingbrook)
• Adventist Bolingbrook Hospital (UChicago Medicine AdventHealth Pharmacy Bolingbrook)
• Adventist Bolingbrook Hospital (Uchicago Medicine Adventhealth Pharmacy Bolingbrook)
• Adventist Bolingbrook Hospital (Uchicago Medicine Adventhealth Pharmacy Bolingbrook)
• Adventist Bolingbrook Hospital (Adventist Bolingbrook Orthopedics)

• Psychiatric Hospital Unit in Bolingbrook, IL
• Providers in Bolingbrook, IL by specialty
• Psychiatric Hospital Unit in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.