Active NPI
Adventist Bolingbrook Hospital
Doing business as Adventhealth Bolingbrook
- General Acute Care Hospital
- Bolingbrook, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Acute Care Hospital
- Legal business name
- ADVENTIST BOLINGBROOK HOSPITAL
- Doing business as
- Adventhealth Bolingbrook
Uchicago Medicine Adventhealth Bolingbrook - Practice address
- 500 Remington Blvd
Bolingbrook, IL 60440-4906 - Phone
- (630) 312-5000
- Fax
- (630) 312-6800
- NPI assigned
- Aug 27, 2006
- Last updated
- Jan 17, 2024
- 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
- Tristan Shaw
- Title
- Cfo
- Phone
- (708) 245-2211
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | Primary |
Addresses
Primary practice location
500 Remington Blvd
Bolingbrook, IL 60440-4906
Mailing address
500 Remington Blvd
Bolingbrook, IL 60440-4906
Phone (630) 312-5000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 50667 | Other | IL | BLUE CROSS |
Other names 2
- ADVENTHEALTH BOLINGBROOK
- UCHICAGO MEDICINE ADVENTHEALTH BOLINGBROOK
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://www.mettles.com/ | Other | |
| CONNECT URL | https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler | Other | CMS HIH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071112000016 | IL | Part A Provider - Hospital | 1456449396 | Practice locations: Woodridge, IL; Romeoville, IL; Plainfield, IL; Naperville, IL; Lemont, IL; Hinsdale, IL; Bolingbrook, IL |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1164530465. Details of each certification follow.
Hospital certification: CCN 140304
- Legal name
- ADVENTIST BOLINGBROOK HOSPITAL
- Doing business as
- UCHICAGO MEDICINE ADVENTHEALTH BOLINGBROOK
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Feb 21, 2008
- Last certification
- Nov 30, 2018
- Beds
- 138
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation
- Incorporated
- Nov 25, 2003 in IL
- Enrollment address
- 500 Remington Blvd
Bolingbrook, IL 60440-4906 - Hospital subgroups
- Acute care, Psychiatric
Related certifications (CCN) 1
Facilities connected through Provider of Services related, parent or unit certification numbers.
-
dba Adventhealth Bolingbrook
- Psychiatric Hospital Unit
- Bolingbrook, IL
- NPI 1013372440
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Adventhealth Bolingbrook
- Psychiatric Hospital Unit
- Bolingbrook, IL
- NPI 1013372440
1456449396
-
dba Adventhealth Bolingbrook
- Cardiovascular Disease Physician
- Bolingbrook, IL
- NPI 1477790160
1456449396
Care Compare: Hospital
Medicare Care Compare- Listed as
- Uchicago Medicine Adventhealth Bolingbrook
- Overall star rating
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
National Provider Directory
National Provider Directory- Tax ID family
- Adventist Bolingbrook Hospital
Other organizations with this tax ID 7
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Adventhealth Bolingbrook
- Psychiatric Hospital Unit
- Bolingbrook, IL
- NPI 1013372440
-
dba UChicago Medicine AdventHealth Pharmacy Bolingbrook
- Community/Retail Pharmacy
- Bolingbrook, IL
- NPI 1184923260
-
dba Uchicago Medicine Adventhealth Pharmacy Bolingbrook
- Specialty Pharmacy
- Bolingbrook, IL
- NPI 1205120706
-
dba Uchicago Medicine Adventhealth Pharmacy Bolingbrook
- Specialty Pharmacy
- Bolingbrook, IL
- NPI 1336925817
-
dba Adventist Bolingbrook Orthopedics
- Orthopaedic Surgery Physician
- Bolingbrook, IL
- NPI 1386015642
-
dba Adventhealth Bolingbrook
- Cardiovascular Disease Physician
- Bolingbrook, IL
- NPI 1477790160
-
dba Uchicago Medicine Adventhealth Imaging Plainfield
- General Acute Care Hospital
- Plainfield, IL
- NPI 1578478962
Member of 2
Organizations this organization is a member of, according to the National Provider Directory.
-
dba Hinsdale Hospital Pediatric Services
- Pediatrics Physician
- Hinsdale, IL
- NPI 1578746178
Member Of
Ownership & related parties
All disclosed owners & managing parties 47
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 |
|---|---|---|---|
| Susan Dixon | Corporate Director | Jan 1, 2022 | |
| Vafa Shayani | Corporate Director | Jan 1, 2024 | |
| Sandra R Valaitis | Corporate Director | Jan 1, 2023 | |
| Nicholas S Moy | Corporate Director | Dec 18, 2025 | |
| Elden Ramirez | Corporate Director | Jan 1, 2022 | |
| Jeffrey Graff | Corporate Officer | Sep 11, 2014 | |
| Glynn Scott | Corporate Director | Aug 18, 2006 | |
| Brent G Snyder | Corporate Director | Aug 17, 2006 | |
| Karsten Randolph | Corporate Officer | Jan 1, 2023 | |
| Eunmee Shim | Contracted Managing Employee | Jun 1, 2026 | |
| Corporate Officer | Jun 1, 2026 | ||
| Operational/Managerial Control | Jun 1, 2026 | ||
| Andrew D Jahn | Corporate Officer | Apr 1, 2024 | |
| Corporate Director | Apr 1, 2024 | ||
| Peter Oconnor | Corporate Director | Dec 9, 2010 | |
| Aytek Oto | Corporate Director | Jan 1, 2023 | |
| Linda Eastman | Corporate Director | Dec 5, 2013 | |
| Michael Saunders | Corporate Officer | Feb 22, 2007 | |
| Adventist Midwest Health | 5% Or Greater Direct Ownership Interest | Feb 1, 2015 | 100% |
| Arnon E Rubin | Corporate Director | Dec 18, 2025 | |
| Jesse Sutton | Corporate Officer | Sep 23, 2025 | |
| Audrey E. Gregory | Corporate Officer | Dec 18, 2025 | |
| Corporate Director | Dec 18, 2025 | ||
| Timothy Pursley | Corporate Director | Jun 6, 2024 | |
| Venanzio Arquilla | Corporate Director | Sep 17, 2009 | |
| Adventist Health System Sunbelt Healthcare Corporation | 5% Or Greater Indirect Ownership Interest | Jan 1, 2023 | 49% |
| Kyle R Glass | Corporate Officer | Jan 14, 2024 | |
| Cherese Chery | Corporate Officer | Jan 1, 2023 | |
| Amanda Brady | Corporate Officer | Sep 23, 2025 | |
| Toni Berrios | Corporate Officer | Sep 23, 2025 | |
| Monica Reed | Corporate Officer | Feb 19, 2024 | |
| Corporate Director | Feb 19, 2024 | ||
| Tom Jackiewicz | Corporate Officer | Jan 1, 2023 | |
| Corporate Director | Jan 1, 2023 | ||
| Haney Vincent | Corporate Officer | Jan 1, 2023 | |
| John Grys | Corporate Director | Jan 1, 2023 | |
| Amy Ross | Corporate Director | Jun 6, 2024 | |
| The University of Chicago Medical Center | 5% Or Greater Indirect Ownership Interest | Jan 1, 2023 | 51% |
| David L Huffman | Corporate Officer | Sep 23, 2025 | |
| Robert C Foltz | Corporate Officer | Sep 11, 2014 | |
| Jonathan Wright | Corporate Director | Dec 1, 2007 | |
| Sanjay K Patari | Corporate Director | Jan 1, 2023 | |
| Lynn Addiscott | Corporate Officer | Aug 18, 2005 | |
| Paul D Ryan | Corporate Director | Jan 1, 2024 | |
| Ivan Samstein | Corporate Director | Jan 1, 2023 | |
| Aziz Ahmed | Corporate Director | Dec 18, 2025 | |
| Ron Hawkins | Corporate Director | Feb 24, 2011 | |
| Tristan Shaw | Contracted Managing Employee | Aug 13, 2023 | |
| Corporate Officer | Aug 13, 2023 | ||
| Operational/Managerial Control | Aug 13, 2023 | ||
| Maninder Kohli | Corporate Director | Jan 1, 2022 | |
| Stacie K Levine | Corporate Director | Sep 26, 2024 | |
| William Holder | Corporate Director | Jun 9, 2016 | |
| Beverly Morgan | Corporate Officer | Sep 23, 2025 | |
| Adventist Health System Sunbelt Inc | 5% Or Greater Indirect Ownership Interest | Jan 1, 2023 | 49% |
Owners & managing parties with NPI records 20
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- General Acute Care Hospital
- Hinsdale, IL
- NPI 1265465439
5% Or Greater Direct Ownership Interest
-
dba Adventhealth Hinsdale
- Psychiatric Hospital Unit
- Hinsdale, IL
- NPI 1447270780
5% Or Greater Direct Ownership Interest
-
dba Uchicago Medicine Adventhealth Home Care
- Home Health Agency
- La Grange, IL
- NPI 1457397317
5% Or Greater Direct Ownership Interest
-
dba Adventist St. Thomas Hospice
- Community Based Hospice Care Agency
- Hinsdale, IL
- NPI 1821020132
5% Or Greater Direct Ownership Interest
-
dba Adventhealth Hinsdale
- Cardiovascular Disease Physician
- Hinsdale, IL
- NPI 1962570382
5% Or Greater Direct Ownership Interest
-
- Interventional Cardiology Physician
- Bloomingdale, IL
- NPI 1962403998
Corporate Director
-
- Geriatric Medicine (Internal Medicine) Physician
- Chicago, IL
- NPI 1932261484
Corporate Director
-
- Orthopaedic Surgery Physician
- Hoffman Estates, IL
- NPI 1083662068
Corporate Director
Facilities with the same owner 93
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Adventhealth Bolingbrook
- Psychiatric Hospital Unit
- Bolingbrook, IL
- NPI 1013372440
Adventist Health System Sunbelt Healthcare Corporation, Adventist Health System Sunbelt Inc, Adventist Midwest Health, The University of Chicago Medical Center
-
dba Adventhealth Glenoaks
- General Acute Care Hospital
- Glendale Heights, IL
- NPI 1760415939
Adventist Health System Sunbelt Healthcare Corporation, Adventist Health System Sunbelt Inc, Adventist Midwest Health, The University of Chicago Medical Center
-
- General Acute Care Hospital
- Hinsdale, IL
- NPI 1265465439
Adventist Health System Sunbelt Healthcare Corporation, Adventist Health System Sunbelt Inc, Adventist Midwest Health, The University of Chicago Medical Center
-
dba Adventhealth la Grange
- General Acute Care Hospital
- La Grange, IL
- NPI 1407889652
Adventist Health System Sunbelt Healthcare Corporation, Adventist Health System Sunbelt Inc, The University of Chicago Medical Center
-
dba Adventhealth Hinsdale
- Psychiatric Hospital Unit
- Hinsdale, IL
- NPI 1447270780
Adventist Health System Sunbelt Healthcare Corporation, Adventist Health System Sunbelt Inc, Adventist Midwest Health, The University of Chicago Medical Center
-
dba Uchicago Medicine Adventhealth Home Care
- Home Health Agency
- La Grange, IL
- NPI 1457397317
Adventist Health System Sunbelt Healthcare Corporation, Adventist Health System Sunbelt Inc, Adventist Midwest Health, The University of Chicago Medical Center
-
dba Adventhealth la Grange
- Rehabilitation Hospital Unit
- La Grange, IL
- NPI 1588068274
Adventist Health System Sunbelt Healthcare Corporation, Adventist Health System Sunbelt Inc, The University of Chicago Medical Center
-
dba Adventist St. Thomas Hospice
- Community Based Hospice Care Agency
- Hinsdale, IL
- NPI 1821020132
Adventist Health System Sunbelt Healthcare Corporation, Adventist Health System Sunbelt Inc, Adventist Midwest Health, The University of Chicago Medical Center
-
- Rehabilitation Hospital Unit
- Harvey, IL
- NPI 1023105566
The University of Chicago Medical Center
-
- General Acute Care Hospital
- Harvey, IL
- NPI 1598756686
The University of Chicago Medical Center
-
dba Ingalls Home Hospice
- Community Based Hospice Care Agency
- Harvey, IL
- NPI 1326083395
The University of Chicago Medical Center
Practitioners & affiliated clinicians
Affiliated clinicians 531
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Clinical Cardiac Electrophysiology Physician
- Joliet, IL
- NPI 1588721328
Hospital
-
- Clinical Cardiac Electrophysiology Physician
- Hinsdale, IL
- NPI 1487637567
Hospital
-
- Pain Medicine (Anesthesiology) Physician
- Arlington Heights, IL
- NPI 1508889023
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156636800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1705449600000",
"number": "1164530465",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 REMINGTON BLVD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604404906",
"telephone_number": "630-312-5000",
"fax_number": "630-312-6800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 REMINGTON BLVD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604404906",
"telephone_number": "630-312-5000",
"fax_number": "630-312-6800"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ADVENTIST BOLINGBROOK HOSPITAL",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-27",
"last_updated": "2024-01-17",
"certification_date": "2024-01-17",
"status": "A",
"authorized_official_last_name": "SHAW",
"authorized_official_first_name": "TRISTAN",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "708-245-2211"
},
"taxonomies": [
{
"code": "282N00000X",
"taxonomy_group": "",
"desc": "General Acute Care Hospital",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "50667",
"state": "IL"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://www.mettles.com/",
"affiliation": "N",
"endpointDescription": "2.16.840.1.113883.3.6037.1",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"address_1": "10320 Little Patuxent Pkwy Ste 233-02",
"city": "Columbia",
"state": "MD",
"country_code": "US",
"postal_code": "210443313",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler",
"affiliation": "Y",
"endpointDescription": "2.16.840.1.113883.13.34.110.1.998.01",
"affiliationName": "CMS HIH",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "CMS esMD eMDR",
"address_1": "7500 Security Blvd",
"city": "Baltimore",
"state": "MD",
"country_code": "US",
"postal_code": "212441849",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "ADVENTHEALTH BOLINGBROOK",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "ADVENTHEALTH BOLINGBROOK",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "UCHICAGO MEDICINE ADVENTHEALTH BOLINGBROOK",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Bolingbrook, IL
- Advanced Professionals Healthcare, LLC
- Advantage Care Services Inc
- Advantage Surgical Assistants, Inc.
- Advantage Surgical Assisting
- Adventist Bolingbrook Hospital (Adventhealth Bolingbrook)
- Adventist Bolingbrook Hospital (UChicago Medicine AdventHealth Pharmacy Bolingbrook)
- Adventist Bolingbrook Hospital (Uchicago Medicine Adventhealth Pharmacy Bolingbrook)
- Adventist Bolingbrook Hospital (Uchicago Medicine Adventhealth Pharmacy Bolingbrook)
- Adventist Bolingbrook Hospital (Adventist Bolingbrook Orthopedics)
- Adventist Bolingbrook Hospital (Adventhealth Bolingbrook)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2024; 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.