NPIMap

Organization Active NPI

Lutheran Retirement Center Association

Doing business as Concordia Village Care Center

  • Skilled Nursing Facility
  • Springfield, IL
National Provider Identifier
1225310246
Registry record updated Aug 25, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0051078 Issued in IL
Legal business name
LUTHERAN RETIREMENT CENTER ASSOCIATION
Doing business as
Concordia Village Care Center
Practice address
4101 W Iles Ave
Springfield, IL 62711-7051
Phone
(217) 793-9429
Fax
(217) 793-1333
NPI assigned
Sep 15, 2011
Last updated
Aug 25, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2020

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

Authorized official

Name
Mr. Chadwick Sneed
Title
Sr Vice President of Finance
Phone
(314) 968-9313

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0051078 IL Primary

Addresses

Primary practice location

4101 W Iles Ave
Springfield, IL 62711-7051

Mailing address

4101 W Iles Ave
Springfield, IL 62711-7051
Phone (217) 793-9429

Other names 1

  • Concordia Village Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120110000764 IL Part A Provider - Skilled Nursing Facility 8224204409 Practice locations: Springfield, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225310246. Details of each certification follow.

Skilled nursing facility certification: CCN 146154

Legal name
LUTHERAN RETIREMENT CENTER ASSOCIATION
Doing business as
CONCORDIA VILLAGE CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
May 1, 2012
Last certification
Aug 22, 2024
Beds
64 (62 certified)
Ownership / control type
Church Related
Multi-facility organization
EverTrue
Organization structure
CorporationNon-profit
Incorporated
May 14, 1996 in IL
Enrollment address
4101W Iles Ave
Springfield, IL 62711-7051

Care Compare: Nursing home

Medicare Care Compare
Listed as
Concordia Village Care CenterCCN 146154 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Church related
Certified
May 1, 2012
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6250.0 residents per day on average
Penalties (3 years)
1Fines totaling $8,678

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

4101 W Iles Ave
Springfield, IL 62711
Phone (217) 793-9429

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Lisa Sombart Individual Corporate DirectorBoard Member Apr 25, 2017
David a Anderson Individual Corporate DirectorBoard Member Jul 1, 2019
Adam Marles Individual Corporate OfficerPresident/Ceo Nov 1, 2021
Corporate DirectorBoard Member Nov 1, 2021
W-2 Managing EmployeePresident/Ceo Nov 1, 2021
Elise McCline Individual Corporate DirectorBoard Member Jul 1, 2021
Lutheran Senior Services Organization, Saint Louis, MO Corporation, Non-profit 5% Or Greater Direct Ownership Interest Dec 12, 2011 100%
5% Or Greater Security Interest Dec 12, 2011 100%
Operational/Managerial Control Dec 12, 2011
John a Komlos Individual Corporate DirectorBoard Member Apr 23, 2013
Norman a Toon Individual Corporate DirectorBoard Member Jul 1, 2019
Garry L Anderson Individual Corporate OfficerChief Operating Officer Nov 1, 2021
W-2 Managing EmployeeChief Operating Officer Nov 1, 2021
Chadwick Sneed Individual Corporate OfficerCfo Jul 1, 2020
Corporate DirectorBoard Member Jul 1, 2020
W-2 Managing EmployeeCfo Jul 1, 2020
Megan Meadows Individual Corporate DirectorBoard Member Jan 24, 2022
Diane R Drollinger Individual Corporate DirectorBoard Member Mar 24, 2014
Jacque K Bogner Individual W-2 Managing EmployeeExecutive Director Apr 2, 2007
Daniel S Brown Individual Corporate DirectorAsst Secretary Apr 25, 2018
Frederick M Kuhlmann Individual Corporate DirectorSecretary Apr 28, 2015
Joel T Christiansen Individual Corporate DirectorBoard Member Jan 24, 2022
Roy Christell Individual Corporate DirectorBoard Member Apr 25, 2017
Paul Tice Individual Corporate DirectorVice Chairperson Apr 25, 2017
Julie Bantle Individual Corporate DirectorBoard Member Jul 1, 2019
Jeffrey Dunn Individual Corporate DirectorChairperson Apr 25, 2018
Harry Mueller Individual Corporate DirectorBoard Member Apr 28, 2015

Owners & managing parties with NPI records 11

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

  • Lutheran Senior Services

    dba Lutheran Home, The

    • Skilled Nursing Facility
    • Peoria, IL
    • NPI 1174239826

    5% Or Greater Direct Ownership Interest, 5% Or Greater Security Interest, Operational/Managerial Control

    CMS ownership
  • Lutheran Senior Services

    dba Meridian Village Care Center

    • Skilled Nursing Facility
    • Glen Carbon, IL
    • NPI 1932814548

    5% Or Greater Direct Ownership Interest, 5% Or Greater Security Interest, Operational/Managerial Control

    CMS ownership
  • Frederick Matthew Kuhlmann, MD
    • Infectious Disease Physician
    • Saint Louis, MO
    • NPI 1417981481

    Corporate Director

    CMS ownership
  • Lutheran Senior Services

    dba Lutheran Convalescent Home

    • Skilled Nursing Facility
    • Webster Groves, MO
    • NPI 1144314386

    5% Or Greater Direct Ownership Interest, 5% Or Greater Security Interest, Operational/Managerial Control

    CMS ownership
  • Lutheran Senior Services

    dba LSS Palliative Care

    • Clinic/Center
    • Saint Louis, MO
    • NPI 1528763885

    5% Or Greater Direct Ownership Interest, 5% Or Greater Security Interest, Operational/Managerial Control

    CMS ownership
  • Lutheran Senior Services

    dba Lenoir Health Care Center

    • Skilled Nursing Facility
    • Columbia, MO
    • NPI 1548354624

    5% Or Greater Direct Ownership Interest, 5% Or Greater Security Interest, Operational/Managerial Control

    CMS ownership
  • Lutheran Senior Services

    dba LSS Hospice Care

    • Community Based Hospice Care Agency
    • Saint Louis, MO
    • NPI 1568592442

    5% Or Greater Direct Ownership Interest, 5% Or Greater Security Interest, Operational/Managerial Control

    CMS ownership
  • Lutheran Senior Services

    dba Lutheran Senior Services at Breeze Park

    • Skilled Nursing Facility
    • Weldon Spring, MO
    • NPI 1720172869

    5% Or Greater Direct Ownership Interest, 5% Or Greater Security Interest, Operational/Managerial Control

    CMS ownership
  • Lutheran Senior Services

    dba Lutheran Senior Services Home Health

    • Home Health Agency
    • Saint Louis, MO
    • NPI 1770664161

    5% Or Greater Direct Ownership Interest, 5% Or Greater Security Interest, Operational/Managerial Control

    CMS ownership
  • Lutheran Senior Services

    dba Lutheran Senior Services at Meramec Bluffs

    • Skilled Nursing Facility
    • Ballwin, MO
    • NPI 1982633053

    5% Or Greater Direct Ownership Interest, 5% Or Greater Security Interest, Operational/Managerial Control

    CMS ownership
  • Lutheran Senior Services

    dba Mason Pointe Care Center

    • Skilled Nursing Facility
    • Chesterfield, MO
    • NPI 1992160949

    5% Or Greater Direct Ownership Interest, 5% Or Greater Security Interest, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 7

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1316044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598313600000",
    "number": "1225310246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4101 W ILES AVE",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627117051",
            "telephone_number": "217-793-9429",
            "fax_number": "217-793-1333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 W ILES AVE",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627117051",
            "telephone_number": "217-793-9429",
            "fax_number": "217-793-1333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUTHERAN RETIREMENT CENTER ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-15",
        "last_updated": "2020-08-25",
        "certification_date": "2020-08-25",
        "status": "A",
        "authorized_official_last_name": "SNEED",
        "authorized_official_first_name": "CHADWICK",
        "authorized_official_title_or_position": "SR VICE PRESIDENT OF FINANCE",
        "authorized_official_telephone_number": "314-968-9313",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0051078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Concordia Village Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Concordia Village Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.