Beacon Pace Illinois LLC

Primary specialty

PACE Provider OrganizationTaxonomy code 251T00000X

Legal business name

BEACON PACE ILLINOIS LLC

Practice address

1700 167TH St
Calumet City, IL 60409-5458

Phone

(855) 801-2653

NPI assigned

Aug 14, 2024

Organization subpart

No

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

Authorized official

Name

Micheal Y Czermak

Title

Cao

Phone

(855) 801-2653

Specialties & licenses 1

Addresses

Other names 1

• BoldAge PACE Illinois Doing business as

Tax ID family

Beacon Pace Illinois LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Beacon Pace Illinois LLC

  • PACE Provider Organization
  • Crestwood, IL
  • NPI 1538991104
  NPD tax ID

Locations

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

{
    "created_epoch": "1723593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767657600000",
    "number": "1073345641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 W MOORE AVE",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281153551",
            "telephone_number": "732-806-3205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 167TH ST",
            "city": "CALUMET CITY",
            "state": "IL",
            "postal_code": "604095458",
            "telephone_number": "855-801-2653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON PACE ILLINOIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-14",
        "last_updated": "2026-01-06",
        "certification_date": "2026-01-06",
        "status": "A",
        "authorized_official_last_name": "CZERMAK",
        "authorized_official_first_name": "MICHEAL",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "CAO",
        "authorized_official_telephone_number": "855-801-2653"
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BoldAge PACE Illinois",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BoldAge PACE Illinois",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• PACE Provider Organization in Calumet City, IL
• Providers in Calumet City, IL by specialty
• PACE Provider Organization in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.