NPIMap

Organization Active NPI

Panoptic Health Service Inc

  • Home Health Agency
  • Morris, IL
National Provider Identifier
1104181932
Registry record updated May 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
1011613 Issued in IL
Legal business name
PANOPTIC HEALTH SERVICE INC
Practice address
1802 N Division St Ste 202
Morris, IL 60450-3104
Phone
(815) 513-3298
Fax
(815) 513-5446
NPI assigned
Jul 9, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2022

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

Authorized official

Name
Gerald Mertes
Title
Ceo
Phone
(815) 513-3298

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 1011613 IL Primary

Addresses

Primary practice location

1802 N Division St Ste 202
Morris, IL 60450-3104

Mailing address

1802 N Division St Ste 202
Morris, IL 60450-3104
Phone (815) 513-3298

Other names 1

  • Panoptic Home Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131122001920 IL Part A Provider - Home Health Agency 9436385390 Practice locations: Morris, IL

Home health agency certification: CCN 148367

Legal name
PANOPTIC HEALTH SERVICE INC
Doing business as
PANOPTIC HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Nov 12, 2014
Last certification
Nov 12, 2014
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
May 20, 2022 in IL
Enrollment address
1802 N Division St
Ste 202
Morris, IL 60450-3104

Care Compare: Home health agency

Medicare Care Compare
Listed as
Panoptic Home HealthCCN 148367
Overall star rating
2.5 of 5
Ownership
Proprietary
Certified
Nov 12, 2014
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
14D2059901Panoptic Home Health1802 N Division St, Ste 202, Morris, IL 60450Certificate of waiverJun 2, 2027

National Provider Directory

National Provider Directory

Locations

760 E Division St
Coal City, IL 60416
Phone (815) 518-5319

1802 N Division St
Ste 202
Morris, IL 60450
Phone (815) 513-3298

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
Amanda Mertes Individual 5% Or Greater Direct Ownership Interest May 20, 2012 30%
Corporate DirectorSecretary May 20, 2012 25%
Jenn Houng Yo Individual 5% Or Greater Direct Ownership Interest May 20, 2012 30%
Corporate DirectorTreasurer May 20, 2012 30%
Larry L Panozzo Individual 5% Or Greater Direct Ownership Interest May 20, 2012 30%
Corporate DirectorVice President/Alternate Adminis May 20, 2012 25%
W-2 Managing EmployeeVice President/Alt Admin May 20, 2012 50%
Gerald E Mertes Individual 5% Or Greater Direct Ownership Interest May 20, 2012 10%
Corporate DirectorPresident/Administrator May 20, 2012 25%
W-2 Managing EmployeePresident/Administrator May 20, 2012 50%

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Affiliated clinicians 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1341792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651795200000",
    "number": "1104181932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1802 N DIVISION ST STE 202",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "604503104",
            "telephone_number": "815-513-3298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1802 N DIVISION ST STE 202",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "604503104",
            "telephone_number": "815-513-3298",
            "fax_number": "815-513-5446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANOPTIC HEALTH SERVICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-09",
        "last_updated": "2022-05-06",
        "certification_date": "2021-04-30",
        "status": "A",
        "authorized_official_last_name": "MERTES",
        "authorized_official_first_name": "GERALD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "815-513-3298"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IL",
            "license": "1011613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Panoptic Home Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Panoptic Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Morris, IL

Sources for this page

Verify at the official NPI Registry.