NPIMap

Organization Active NPI

SSM Health Businesses

Doing business as SSM Health at Home Hospice Glen Carbon

  • Community Based Hospice Care Agency
  • Mount Vernon, IL
National Provider Identifier
1093718900
Registry record updated Aug 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
2002665 Issued in IL
Legal business name
SSM HEALTH BUSINESSES
Doing business as
SSM Health at Home Hospice Glen Carbon
SSM Health at Home Hospice Mt. Vernon
Practice address
1501 McPherson Ave
Mount Vernon, IL 62864-2831
Phone
(618) 899-1624
Fax
(615) 899-4744
NPI assigned
May 24, 2005
Last updated
Aug 1, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2023

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

Authorized official

Name
Lisa Schweitzer, RN
Title
Vice President Patient Care Service
Phone
(608) 778-2146

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 2002665 IL Primary

Addresses

Primary practice location

1501 McPherson Ave
Mount Vernon, IL 62864-2831

Mailing address

1501 McPherson Ave
Mount Vernon, IL 62864-2831

Other practice location 1

20 Junction Dr W Ste 4
Glen Carbon, IL 62034-3060
Phone (618) 899-1651

Other names 2

  • SSM Health at Home Hospice Glen Carbon Doing business as
  • SSM Health at Home Hospice Mt. Vernon Doing business as

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080616000390 IL Part A Provider - Hospice 8022107051 Practice locations: Mount Vernon, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093718900. Details of each certification follow.

Hospice certification: CCN 141530

Legal name
SSM HEALTH BUSINESSES
Doing business as
SSM HEALTH AT HOME HOSPICE ILLINOIS
Certification status
Active
Provider type (POS)
Hospice
Participating since
Nov 9, 1989
Last certification
Jan 30, 2020
Ownership / control type
Proprietary - Other
Organization structure
CorporationNon-profit
Enrollment address
1501 McPherson Ave
Mount Vernon, IL 62864-2831

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
SSM Hospice of IllinoisCCN 141530 · All quality measures
Ownership
Non-Profit
Certified
Nov 9, 1989
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Good Samaritan Regional Health Center9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

20 Junction Dr W
Ste 4
Glen Carbon, IL 62034
Phone (618) 288-8020

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Amy Lillge Individual Corporate DirectorAdministrator/Vice President of Apr 26, 2026
W-2 Managing EmployeeAd; Apr 24, 2026
Kari Krueger Individual Corporate OfficerRegional VP of Finance Sep 2, 2022
Corporate DirectorRegional VP of Finance Sep 2, 2022
W-2 Managing EmployeeRegional VP of Finance Sep 2, 2022
Kelli Denise Koons Individual W-2 Managing EmployeeMD;Reginal Cfo Nov 19, 2007
SSM Health Businesses Organization, St Louis, MO Non-profit Operational/Managerial Control Jan 1, 2008
Laura Kaiser Individual Corporate OfficerPresident Ceo Aug 1, 2017 100%

Owners & managing parties with NPI records 6

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

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
SSM Health at Home Home Health-WisconsinMadison, WI, CCN 527184 Home health agency 5% Or Greater Direct Ownership Interest (100%) Mar 29, 2024
SSM Health at Home Home Health- OklahomaOklahoma City, OK, CCN 377035A Home health agency Operational/Managerial Control Apr 1, 2000
SSM Health at Home Hospice-OklahomaOklahoma City, OK, CCN 371731 Hospice 5% Or Greater Direct Ownership Interest May 23, 1984

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 3

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

NPI Registry JSON

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690848000000",
    "number": "1093718900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 MCPHERSON AVE",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 MCPHERSON AVE",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642831",
            "telephone_number": "618-899-1624",
            "fax_number": "615-899-4744"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20 Junction Dr W Ste 4",
            "address_purpose": "LOCATION",
            "city": "Glen Carbon",
            "state": "IL",
            "postal_code": "620343060",
            "country_code": "US",
            "telephone_number": "618-899-1651",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SSM HEALTH BUSINESSES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-24",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A",
        "authorized_official_last_name": "SCHWEITZER",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "VICE PRESIDENT PATIENT CARE SERVICE",
        "authorized_official_telephone_number": "608-778-2146",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "IL",
            "license": "2002665",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "SSM Health at Home Hospice Glen Carbon",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SSM Health at Home Hospice Mt. Vernon",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Vernon, IL

Sources for this page

Verify at the official NPI Registry.