Bristol Hospice - Chicago, L.L.C.
Organization Active NPI Community Based Hospice Care Agency · Des Plaines, IL
NPI 1104548478 · NPPES record last updated Feb 11, 2026
Key facts
- NPI
- 1104548478
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- BRISTOL HOSPICE - CHICAGO, L.L.C.
- Practice address
- 2800 S River Rd Ste 440
Des Plaines, IL 60018-4202 - Phone
- (872) 777-1750
- Fax
- (872) 702-6450
- NPI assigned
- Sep 14, 2022
- Organization subpart
- Yes
- Parent organization (as reported)
- BRISTOL HOSPICE, L.L.C.
Authorized official
- Name
- Mr. Alex Mauricio
- Title
- President
- Phone
- (801) 325-0175
Owners & managing parties with NPI records 1
-
Sachin Jain, MD
Facilities with the same owner 52
Practitioners 1
Affiliated clinicians 4
-
Sachin Jain, MD
-
Sunnan Moinuddin, MD
-
Ellis J Talbert, MD
Medicare Care Compare: Hospice
- Listed as
- Bristol Hospice - Chicago, LLC
- Certified
- Jul 6, 2023
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D2273091 | Bristol Hospice - Chicago LLC | Certificate of waiver | Dec 5, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IL
Hospice certification: CCN 141727
- Legal name
- BRISTOL HOSPICE - CHICAGO LLC
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Jul 6, 2023
- Last certification
- Jun 30, 2023
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- LLC · Proprietary
- Incorporated
- Jun 29, 2022 in IL
- Enrollment address
- 701 Lee St
Ste 480
Des Plaines, IL 60016-4546
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Bristol Hospice Holdings Inc |
5% Or Greater Indirect Ownership Interest | Feb 10, 2023 | 100% |
| Alex Edward Mauricio |
Corporate Officer |
Jan 1, 2023 | |
| Corporate Director |
Jan 1, 2023 | ||
| Webster Equity Partners Bristol CF LP |
5% Or Greater Indirect Ownership Interest | Feb 10, 2023 | 69.8% |
| John Charles Garbarino |
Corporate Officer |
Oct 26, 2020 | |
| Corporate Director |
Oct 26, 2020 | ||
| Webster Equity Partners IV Bristol CF LP |
5% Or Greater Indirect Ownership Interest | Feb 10, 2023 | 5.72% |
| Michael Derrick |
Corporate Officer |
Sep 1, 2023 | |
| Betty J Brennan |
Corporate Director |
Jul 13, 2018 | |
| Bristol Ultimate Holdco, LP |
5% Or Greater Indirect Ownership Interest | Feb 10, 2023 | 100% |
| Hyrum Kirton |
Corporate Director |
Oct 26, 2020 | |
| Aftab Kagzi |
W-2 Managing Employee |
Jan 2, 2025 | |
| Aware Super Pty, LTD. |
5% Or Greater Indirect Ownership Interest | Jan 24, 2022 | 8.28% |
| Bristol Hospice, L.L.C. |
5% Or Greater Direct Ownership Interest | Feb 10, 2023 | 100% |
| Sachin K Jain |
Contracted Managing Employee |
Nov 1, 2023 | |
| Bristol Hospice Topco Inc |
5% Or Greater Indirect Ownership Interest | Feb 10, 2023 | 100% |
| David a Malm |
Corporate Officer |
Oct 26, 2020 | |
| Corporate Director |
Oct 26, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230512001212 | IL | Part a Provider - Hospice | 1052777232 | Practice locations: Burr Ridge, IL; Des Plaines, IL |
| O20260501002837 | IL | Part B Supplier - Clinic/Group Practice | 1052777232 |
Receives reassigned benefits from 1 practitioner Practice locations: Des Plaines, IL; Burr Ridge, IL |
National Provider Directory
- Part of
- Bristol Hospice LLC
Locations
745 McClintock Dr
Ste 215
Burr Ridge, IL 60527
Phone (331) 265-8900
2800 S River Rd
Ste 440
Des Plaines, IL 60018
Phone (872) 777-1750
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
2800 S River Rd Ste 440
Des Plaines, IL 60018-4202
Mailing address
206 N 2100 W Ste 202
Salt Lake City, UT 84116-4741
Phone (801) 325-0175
Other practice location 1
745 McClintock Dr Ste 215
Burr Ridge, IL 60527-0863
Phone (331) 265-8900
Other providers in Des Plaines, IL
- Megan Elizabeth Bravo
- Magdalene Brej
- Bridget Brewer
- Bridgecare, Inc.
- Brij Chiropractic Inc
- Brite Bite Dental, PC
- Lindsy Abigail Brito
- Shelley Jean Brucar
- Jonathan Buck
- Allison Bulmahn
All providers in Des Plaines, IL · Community Based Hospice Care Agency in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 11, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.