Active NPI
Prime Home Health Services, Inc.
- Home Health Agency
- Park Ridge, IL
National Provider Identifier
1083632715
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- License
- 1010473
- Legal business name
- PRIME HOME HEALTH SERVICES, INC.
- Practice address
- 2604 Dempster St
Suite 407
Park Ridge, IL 60068-8412 - Phone
- (847) 803-8550
- Fax
- (847) 803-6819
- NPI assigned
- Jul 18, 2006
- Last updated
- May 18, 2016
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Sam D Fernandez Sr.
- Title
- President
- Phone
- (847) 803-8550
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 1010473 | IL | Primary |
Addresses
Primary practice location
2604 Dempster St
Suite 407
Park Ridge, IL 60068-8412
Mailing address
2604 Dempster St
Suite 407
Park Ridge, IL 60068-8412
Phone (847) 803-8550
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050727000289 | IL | Part A Provider - Home Health Agency | 8224066758 | Practice locations: Park Ridge, IL |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1083632715. Details of each certification follow.
Home health agency certification: CCN 147865
- Legal name
- PRIME HOME HEALTH SERVICES, INC.
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Apr 11, 2006
- Last certification
- Sep 17, 2020
- Ownership / control type
- Proprietary
- Organization structure
- Corporation
- Incorporated
- Mar 1, 2005 in IL
- Enrollment address
- 2644 Dempster St
Ste T-207
Park Ridge, IL 60068-8411
Care Compare: Home health agency
Medicare Care Compare- Listed as
- Prime Home Health Services, Inc
- Ownership
- Proprietary
- Certified
- Apr 11, 2006
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
National Provider Directory
National Provider DirectoryLocations
2604 Dempster St
Ste 407
Park Ridge, IL 60068
Phone (847) 296-3577
2644 Dempster St
Ste T207
Park Ridge, IL 60068
Phone (847) 803-8550
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.
| Name | Role | Since | Share |
|---|---|---|---|
| Ana Fernandez | W-2 Managing Employee | Jan 19, 2005 | |
| Samuel Fernandez | 5% Or Greater Direct Ownership Interest | Jan 19, 2005 | 33.34% |
| Gaudelia L Tamayo Guzman | 5% Or Greater Direct Ownership Interest | Jan 19, 2005 | 33.33% |
| George Kedra | 5% Or Greater Direct Ownership Interest | Jan 19, 2005 | 33.33% |
Practitioners & affiliated clinicians
Affiliated clinicians 3
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Orthopaedic Surgery Physician
- Chicago, IL
- NPI 1730189598
Home health agency
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1463529600000",
"number": "1083632715",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2604 DEMPSTER ST",
"address_2": "SUITE 407",
"city": "PARK RIDGE",
"state": "IL",
"postal_code": "600688412",
"telephone_number": "847-803-8550",
"fax_number": "847-803-6819"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2604 DEMPSTER ST",
"address_2": "SUITE 407",
"city": "PARK RIDGE",
"state": "IL",
"postal_code": "600688412",
"telephone_number": "847-803-8550",
"fax_number": "847-803-6819"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PRIME HOME HEALTH SERVICES, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-18",
"last_updated": "2016-05-18",
"status": "A",
"authorized_official_last_name": "FERNANDEZ",
"authorized_official_first_name": "SAM",
"authorized_official_middle_name": "D",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "847-803-8550",
"authorized_official_name_prefix": "Mr.",
"authorized_official_name_suffix": "Sr."
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "IL",
"license": "1010473",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Park Ridge, IL
- Prima Medical Practices Inc
- Primary Care Center, S.C.
- Primary Care of Illinois, SC
- Prime Care Resource, Inc.
- Prime Healthcare Senior Living, LLC (Resurrection Place)
- Prime Medical Equipment LLC
- Laura Prince, M.D.
- Priority Anesthesia LLC
- Pro Psych Associates SC
- Procare Dental Group, P.C. (Associates in Dentistry)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2016; 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.