Adventist Bolingbrook Hospital
Organization Active NPI General Acute Care Hospital · Bolingbrook, IL
NPI 1164530465 · NPPES record last updated Jan 17, 2024
Key facts
- NPI
- 1164530465
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- Legal business name
- ADVENTIST BOLINGBROOK HOSPITAL
- Practice address
- 500 Remington Blvd
Bolingbrook, IL 60440-4906 - Phone
- (630) 312-5000
- Fax
- (630) 312-6800
- NPI assigned
- Aug 27, 2006
- Organization subpart
- No
Authorized official
- Name
- Tristan Shaw
- Title
- Cfo
- Phone
- (708) 245-2211
Owners & managing parties with NPI records 20
-
Aziz Ahmed, M.D.
-
Maninder S. Kohli, M.D.
-
Nicholas S. Moy, M.D.
-
Arnon E Rubin, MD
-
Paul D. Ryan, M.D.
-
Vafa Shayani, MD
-
Timothy Jay Pursley, M.D.
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 7
Member of 2
Related certifications (CCN) 1
Facilities with the same owner 93
Affiliated clinicians 531
-
Ahmad Abdul Karim, M.D
-
Keenan Adib, MD
-
Mohammed I. Ahmed, M.D.
-
Mohammad Ahsan, MD
-
Naheed R Akhter, MD
-
Hia Alazzam, APRN, CRNA
-
Rudolph Albores, MD
-
Gary Altwerger, M.D.
-
Nazia Alvi, D.O.
-
Beejal Yashwant Amin, M.D.
-
Nicolas S Anderson, DPM
-
Lazaro Anguiano Munoz, FNP-C
-
Erum Arain, M.D.
-
Imtiaz Arain, MD
-
Susmita Ayyagari, MD
-
Megan Bailey, NP
-
Rizwan S Bajwa, DO
-
Hollie Amber Balazs, APN-CNP
Medicare Care Compare: Hospital
- Listed as
- Uchicago Medicine Adventhealth Bolingbrook
- Overall star rating
- ★★★☆☆ 3 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
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 · Non-profit
- Incorporated
- Nov 25, 2003 in IL
- Enrollment address
- 500 Remington Blvd
Bolingbrook, IL 60440-4906 - Hospital subgroups
- Acute care, Psychiatric
All disclosed owners & managing parties 47
| 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% |
Medicare enrollment records
| 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 |
National Provider Directory
- Tax ID family
- Adventist Bolingbrook Hospital
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 50667 | Other | IL | BLUE CROSS |
Other names
- ADVENTHEALTH BOLINGBROOK
- UCHICAGO MEDICINE ADVENTHEALTH BOLINGBROOK
Electronic endpoints
| 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 |
Other providers in Bolingbrook, IL
- Advanced Professionals Healthcare, LLC
- Advantage Care Services Inc
- Advantage Surgical Assistants, Inc.
- Advantage Surgical Assisting
- Adventist Bolingbrook Hospital
- Adventist Bolingbrook Hospital
- Adventist Bolingbrook Hospital
- Adventist Bolingbrook Hospital
- Adventist Bolingbrook Hospital
- Adventist Bolingbrook Hospital
All providers in Bolingbrook, IL · General Acute Care Hospital in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2024. 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.