Palladian Mt Vernon SNF LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1656261 Issued in IL

Legal business name

PALLADIAN MT VERNON SNF LLC

Doing business as

Mt Vernon Countryside Manor

Practice address

606 E Il Highway 15
Mount Vernon, IL 62864-5072

Phone

(618) 242-1800

Fax

(618) 242-9080

NPI assigned

Oct 11, 2005

Last updated

Mar 18, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Michael Jason Mills

Title

Cfo

Phone

(314) 566-0459

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• MT VERNON COUNTRYSIDE MANOR Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033107248. Details of each certification follow.

• CCN 145685 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 145685

Legal name

PALLADIAN MT VERNON SNF, LLC

Doing business as

MT VERNON COUNTRYSIDE MANOR

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF distinct part

Participating since

Jun 5, 1990

Last certification

Jan 24, 2025

Beds

91

Ownership / control type

Corporation

Multi-facility organization

Palladian Mgmnt

Most recent change of ownership

Mar 1, 2020

Organization structure

LLCProprietary

Incorporated

Sep 19, 2019 in IL

Enrollment address

606 E Il Highway 15
Mount Vernon, IL 62864-5072

Nursing home name

MOUNT VERNON COUNTRYSIDE MANOR

Affiliated entity

PALLADIAN HEALTHCARE

Listed as

Mount Vernon Countryside ManorCCN 145685 · All quality measures

Overall star rating

2 of 5

Health inspections

3 of 5

Staffing

1 of 5

Quality measures

2 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Jun 5, 1990

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

9177.5 residents per day on average

Chain

Palladian Healthcare6 facilities in the chain

Penalties (3 years)

6Fines totaling $126,387

Processed by Care Compare on Aug 1, 2026.

Locations

All disclosed owners & managing parties 2

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

Affiliated clinicians 3

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

• William D Huffstutler, MD

  • Internal Medicine Physician
  • Mount Vernon, IL
  • NPI 1578513420

  Nursing home

  Care Compare affiliation
• Sudeep Nair, MD

  • Internal Medicine Physician
  • Mount Vernon, IL
  • NPI 1376582999

  Nursing home

  Care Compare affiliation
• John A Flick, D.O.

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1770782351

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710720000000",
    "number": "1033107248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1670 ESSEX WAY STE B",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622693063",
            "telephone_number": "618-327-3064",
            "fax_number": "618-327-3083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 E IL HIGHWAY 15",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628645072",
            "telephone_number": "618-242-1800",
            "fax_number": "618-242-9080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALLADIAN MT VERNON SNF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-11",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "status": "A",
        "authorized_official_last_name": "MILLS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "JASON",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "314-566-0459",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "1656261",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3712399286286401",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd Ste B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "MT VERNON COUNTRYSIDE MANOR",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Deborah Overoyen, DDS
• Stacy Owens, LPN
• Oza Oncology Inc.
• Yagnesh V. Oza, M.D.
• Miko Emmanuel Peralta Palad, DPT
• Jacques Papazian, M.D.
• Michaela Parchman, FNP-C
• Walter A Parham, MD
• Deidra Dawn Parks, M.S. CCC/SLP
• Shannon D Parks, APN

• Skilled Nursing Facility in Mount Vernon, IL
• Providers in Mount Vernon, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.