Crescent Home Health Agency, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

1011293 Issued in IL

Legal business name

CRESCENT HOME HEALTH AGENCY, LLC

Doing business as

NA

Practice address

7 Park PL Ste B
Swansea, IL 62226

Phone

(618) 277-0939

Fax

(618) 277-0949

NPI assigned

Feb 15, 2010

Last updated

Aug 28, 2018By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Sikander M Bajwa, PTNPI 1295908358

Title

Ceo/Administrator

Phone

(314) 741-3800

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• NA Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154643328. Details of each certification follow.

• CCN 148190 Home health agency · Active · Details

Home health agency certification: CCN 148190

Legal name

CRESCENT HOME HEALTH AGENCY LLC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Aug 27, 2010

Last certification

Sep 11, 2019

Ownership / control type

Proprietary

Organization structure

LLCProprietary

Incorporated

Dec 3, 2009 in IL

Enrollment address

7 Park PL
Ste B
Swansea, IL 62226-2916

Listed as

Crescent Home Health Agency, LLCCCN 148190 · All quality measures

Ownership

Proprietary

Certified

Aug 27, 2010

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Physical therapy, Speech pathology, Occupational therapy

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 2

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

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sikander M Bajwa, MAOM, PT

  • Physical Therapist
  • Ellisville, MO
  • NPI 1295908358

  Home Health

  NPD (past) Authorized official

Affiliated clinicians 1

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

• Charles W Ampadu, MD

  • Internal Medicine Physician
  • Swansea, IL
  • NPI 1962545269

  Home health agency

  Care Compare affiliation

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

{
    "created_epoch": "1266192000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1535414400000",
    "number": "1154643328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 PARK PL STE B",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622262916",
            "telephone_number": "618-277-0939",
            "fax_number": "618-277-0949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 PARK PL STE B",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "62226",
            "telephone_number": "618-277-0939",
            "fax_number": "618-277-0949"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10 Emerald Terrace",
            "address_2": "Suite C",
            "address_purpose": "LOCATION",
            "city": "Swansea",
            "state": "IL",
            "postal_code": "622262310",
            "country_code": "US",
            "telephone_number": "618-277-0939",
            "fax_number": "618-277-0949",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CRESCENT HOME HEALTH AGENCY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-15",
        "last_updated": "2018-08-28",
        "status": "A",
        "authorized_official_last_name": "BAJWA",
        "authorized_official_first_name": "SIKANDER",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO/ADMINISTRATOR",
        "authorized_official_telephone_number": "314-741-3800",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IL",
            "license": "1011293",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE CCN (PTAN)",
            "identifier": "14-8190",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Home Health Agency in Swansea, IL
• Providers in Swansea, IL by specialty
• Home Health Agency in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2018; 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.

Verify at the official NPI Registry.