NPIMap

Organization Active NPI

Medpro Health Providers LLC

  • Home Health Agency
  • Tinley Park, IL
National Provider Identifier
1073820049
Registry record updated Jul 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
1011286 Issued in IL
Legal business name
MEDPRO HEALTH PROVIDERS LLC
Practice address
16820 Oak Park Ave
Tinley Park, IL 60477-2752
Phone
(708) 240-8088
Fax
(708) 251-1123
NPI assigned
Sep 10, 2010
Last updated
Jul 12, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2021

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

Authorized official

Name
Mr. Rizaldy Larga Villasenor
Title
President / Ceo
Phone
(708) 240-8088

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 1011286 IL Primary

Addresses

Primary practice location

16820 Oak Park Ave
Tinley Park, IL 60477-2752

Mailing address

16325 Harlem Ave Ste 350
Tinley Park, IL 60477-2509
Phone (708) 240-8088

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101122000324 IL Part A Provider - Home Health Agency 3870789431 Practice locations: Tinley Park, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073820049. Details of each certification follow.

Home health agency certification: CCN 148246

Legal name
MEDPRO HEALTH PROVIDERS LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jun 10, 2011
Last certification
Sep 17, 2020
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Apr 13, 2009 in IL
Enrollment address
16820 Oak Park Ave
Tinley Park, IL 60477-2752
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Medpro Health ProvidersCCN 148246 · All quality measures
Overall star rating
4.5 of 5
Ownership
Proprietary
Certified
Jun 10, 2011
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

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
14D2021368Medpro Health Providers LLC16820 Oak Park Ave, Tinley Park, IL 60477Certificate of waiverMar 10, 2027

National Provider Directory

National Provider Directory

Locations

16335 Harlem Ave
Ste 110
Tinley Park, IL 60477
Phone (708) 240-8088

16335 Harlem Ave
Ste 400
Tinley Park, IL 60477
Phone (708) 633-6360

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Jaye Michael Chan Individual 5% Or Greater Direct Ownership Interest Sep 29, 2010
General Partnership Interest Sep 29, 2010
Corporate Director Sep 29, 2010
Rizaldy Villasenor Individual 5% Or Greater Direct Ownership Interest Sep 29, 2010
General Partnership Interest Sep 29, 2010
Corporate Director Sep 29, 2010
W-2 Managing Employee Sep 29, 2010
Operational/Managerial Control Sep 29, 2010
Rey Philip Castillo Individual 5% Or Greater Direct Ownership Interest Sep 29, 2010
General Partnership Interest Sep 29, 2010
Corporate Director Sep 29, 2010
Anthony Ocampo Individual 5% Or Greater Direct Ownership Interest Sep 29, 2010
General Partnership Interest Sep 29, 2010
Corporate Director Sep 29, 2010

Practitioners & affiliated clinicians

Affiliated clinicians 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1284076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626048000000",
    "number": "1073820049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16325 HARLEM AVE STE 350",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604772509",
            "telephone_number": "708-240-8088",
            "fax_number": "708-251-1123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16820 OAK PARK AVE",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604772752",
            "telephone_number": "708-240-8088",
            "fax_number": "708-251-1123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDPRO HEALTH PROVIDERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-10",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A",
        "authorized_official_last_name": "VILLASENOR",
        "authorized_official_first_name": "RIZALDY",
        "authorized_official_middle_name": "LARGA",
        "authorized_official_title_or_position": "PRESIDENT / CEO",
        "authorized_official_telephone_number": "708-240-8088",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IL",
            "license": "1011286",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tinley Park, IL

Sources for this page

Verify at the official NPI Registry.