Stephenson Nursing Center

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

0004259 Issued in IL

Legal business name

STEPHENSON NURSING CENTER

Doing business as

Stephenson Nursing Center

Practice address

2946 S Walnut Rd
Freeport, IL 61032

Phone

(815) 235-6173

Fax

(815) 235-9633

NPI assigned

Nov 9, 2005

Last updated

Feb 17, 2022By 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. Peter Joseph Bolt III

Title

Adm

Phone

(815) 235-6173

Specialties & licenses 1

Addresses

Other names 1

• Stephenson Nursing Center 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 1265413900. Details of each certification follow.

• CCN 145895 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 145895

Legal name

COUNTY OF STEPHENSON

Doing business as

STEPHENSON NURSING CENTER

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Nov 1, 1996

Last certification

Feb 4, 2025

Beds

150 (148 certified)

Ownership / control type

County

Organization structure

OtherNon-profit

Enrollment address

2946 S Walnut Rd
Freeport, IL 61032-9528

Nursing home name

STEPHENSON NURSING CENTER

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• County of Stephenson

  • Public Health or Welfare Agency
  • Freeport, IL
  • NPI 1801959226

  2769483270

  Same PAC ID

Listed as

Stephenson Nursing CenterCCN 145895 · All quality measures

Overall star rating

3 of 5

Health inspections

3 of 5

Staffing

2 of 5

Quality measures

2 of 5

Type

Medicare and Medicaid

Ownership

Government - County

Certified

Nov 1, 1996

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

14870.8 residents per day on average

Penalties (3 years)

2Fines totaling $18,450

Processed by Care Compare on Aug 1, 2026.

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

CLIA laboratory certificates

Tax ID family

Stephenson County Healt2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• County of Stephenson

  • Public Health or Welfare Agency
  • Freeport, IL
  • NPI 1801959226
  NPD tax ID

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.

Owners & managing parties with NPI records 1

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

• County of Stephenson

  • Public Health or Welfare Agency
  • Freeport, IL
  • NPI 1801959226

  5% Or Greater Direct Ownership Interest

  CMS ownership

Affiliated clinicians 3

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

• Robert M Bandera, MD

  • Family Medicine Physician
  • Freeport, IL
  • NPI 1134199458

  Nursing home

  Care Compare affiliation
• Terry L Miller, MD

  • Family Medicine Physician
  • Freeport, IL
  • NPI 1164498366

  Nursing home

  Care Compare affiliation
• Robert N Tiballi, D.O.

  • Infectious Disease Physician
  • Elgin, IL
  • NPI 1194757427

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1131494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645056000000",
    "number": "1265413900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2946 S WALNUT RD",
            "city": "FREEPORT",
            "state": "IL",
            "postal_code": "61032",
            "telephone_number": "815-235-6173",
            "fax_number": "815-235-9633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2946 S WALNUT RD",
            "city": "FREEPORT",
            "state": "IL",
            "postal_code": "61032",
            "telephone_number": "815-235-6173",
            "fax_number": "815-235-9633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHENSON NURSING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-09",
        "last_updated": "2022-02-17",
        "certification_date": "2022-02-17",
        "status": "A",
        "authorized_official_last_name": "BOLT",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "ADM",
        "authorized_official_telephone_number": "815-235-6173",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "0004259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stephenson Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Stephenson Nursing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephen H Spyrison, DDS
• Christina Lee Steele-Lietz, LCSW
• Stephen Perry DC PC (Perry Chiropractic Center)
• Stephenson County Senior Center Dba Senior Resource Center
• Stephenson County Senior Center Dba Senior Resource Center (Pretzel City Area Transit)
• Ian S Stevens
• Phillip Edward Stiles, PA-C
• Angela Marie Stralow
• Donna Jean Strauch
• Judy Ann Strey

• Skilled Nursing Facility in Freeport, IL
• Providers in Freeport, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2022; 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.