Town Square Hospice Illinois LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

TOWN SQUARE HOSPICE ILLINOIS LLC

Practice address

112 W Washington St Ste 2B
Monticello, IL 61856-1668

Phone

(217) 670-6990

Fax

(217) 606-7938

NPI assigned

Apr 17, 2024

Last updated

Mar 7, 2025By 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

Michael Wik

Title

Chairman of the Board

Phone

(330) 588-3803

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1063266716. Details of each certification follow.

• CCN 141744 Hospice · Active · Details

Hospice certification: CCN 141744

Legal name

TOWN SQUARE HOSPICE ILLINOIS LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Apr 23, 2025

Last certification

Apr 17, 2025

Ownership / control type

Proprietary - Other

Organization structure

LLCProprietary

Enrollment address

112 W Washington St
Ste 2B
Monticello, IL 61856-1668

Listed as

Town Square Hospice Illinois LLCCCN 141744 · All quality measures

Certified

Apr 23, 2025

Medicare certification status

ActiveFrom the Provider of Services file

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Hospice of Nebraska LLC

  • Community Based Hospice Care Agency
  • Lincoln, NE
  • NPI 1497592539

  Member Of

  NPD member

Locations

All disclosed owners & managing parties 7

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 1

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

• Muhammad N Khan, MD

  • Internal Medicine Physician
  • Decatur, IL
  • NPI 1598767493

  5% Or Greater Direct Ownership Interest, Operational/Managerial Control

  CMS ownership

Practitioners 1

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.

• Muhammad N Khan, MD

  • Internal Medicine Physician
  • Decatur, IL
  • NPI 1598767493
  NPD

Affiliated clinicians 2

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

• Muhammad N Khan, MD

  • Internal Medicine Physician
  • Decatur, IL
  • NPI 1598767493

  Hospice

  Care Compare affiliation
• Aimee C Yu-Ballard, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Urbana, IL
  • NPI 1083675045

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1713312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741305600000",
    "number": "1063266716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 W WASHINGTON ST STE 2B",
            "city": "MONTICELLO",
            "state": "IL",
            "postal_code": "618561668",
            "telephone_number": "217-670-6990",
            "fax_number": "217-606-7938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 W WASHINGTON ST STE 2B",
            "city": "MONTICELLO",
            "state": "IL",
            "postal_code": "618561668",
            "telephone_number": "217-670-6990",
            "fax_number": "217-606-7938"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOWN SQUARE HOSPICE ILLINOIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-17",
        "last_updated": "2025-03-07",
        "certification_date": "2025-03-07",
        "status": "A",
        "authorized_official_last_name": "WIK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CHAIRMAN OF THE BOARD",
        "authorized_official_telephone_number": "330-588-3803"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community Based Hospice Care Agency in Monticello, IL
• Providers in Monticello, IL by specialty
• Community Based Hospice Care Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2025; 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.