SSM Health Businesses
Organization Active NPI Home Health Agency · Mount Vernon, IL
NPI 1295798403 · NPPES record last updated Aug 1, 2023
Key facts
- NPI
- 1295798403
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- 1010902 (IL)
- Legal business name
- SSM HEALTH BUSINESSES
- Practice address
- 1501 McPherson Ave
Mount Vernon, IL 62864-2831 - Phone
- (618) 899-1621
- Fax
- (618) 899-4744
- NPI assigned
- Apr 10, 2006
- Organization subpart
- No
Authorized official
- Name
- Lisa Schweitzer, RN
- Title
- Vice President Patient Care Service
- Phone
- (608) 778-2146
Owned or controlled facilities with NPI records 4
Other NPIs with the same Medicare PAC ID 5
Corporate family (same tax ID) 8
Affiliated clinicians 57
-
Christopher W Ballard, M.D.
-
Linda Georgette Boulware, APRN
-
Kendra D Bowen, PAC
-
Janet L. Broom, MSN, APRN-BC
-
Michelle Burwell, PA-C
-
Ashley Daniels, FNP
-
Dennon W Davis, M.D.
-
Jason A Davison, NP-C
-
Laura Devous, FNP
-
Robert Dow, MD
-
Angela Freehill, MD
-
Braedon Haertling, PA-C
-
Seth Hahs, MD
-
Kristina M Hastings, FNP-BC
-
Alec Bruce Hood, MD
-
Jean Benoit Houle, M.D.
-
Karen Diane Hummel, PAC
-
Gautam Jha, MD
-
Naeem Anwar Khan, MD
-
Suresh Krishnamoorthy, M.D.
-
Paul Ryan Lane, PA-C
Medicare Care Compare: Home health agency
- Listed as
- SSM Health at Home Health-Illinois
- Overall star rating
- ★★★☆☆ 3 of 5
- Ownership
- Proprietary
- Certified
- Nov 4, 1968
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Occupational therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Home health agency certification: CCN 147088
- Legal name
- SSM HEALTH BUSINESSES
- Doing business as
- SSM HEALTH AT HOME HOME HEALTH-ILLINOIS
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Nov 4, 1968
- Last certification
- Mar 11, 2021
- Ownership / control type
- Proprietary
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 24, 1984 in MO
- Enrollment address
- 1501 McPherson Ave
Mount Vernon, IL 62864-2831
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Lisa Schweitzer |
Corporate Officer |
Sep 2, 2022 | |
| Corporate Director |
Sep 2, 2022 | ||
| Kari Krueger |
Corporate Officer |
Sep 2, 2022 | |
| Corporate Director |
Sep 2, 2022 | ||
| W-2 Managing Employee |
Sep 2, 2022 | ||
| Rebecca Shaw |
Operational/Managerial Control |
Jan 3, 2022 | |
| Steven Smoot |
Corporate Director |
Jul 30, 2018 |
All facility ownership & control disclosures 4
| Facility | Type | Role | Since |
|---|---|---|---|
| SSM Health at Home Home Health-Wisconsin |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Mar 29, 2024 |
| SSM Health at Home Home Health- Oklahoma |
Home health agency | Operational/Managerial Control | Apr 1, 2000 |
| SSM Health at Home Hospice Illinois |
Hospice | Operational/Managerial Control | Jan 1, 2008 |
| SSM Health at Home Hospice-Oklahoma |
Hospice | 5% Or Greater Direct Ownership Interest | May 23, 1984 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20081210000554 | IL | Part a Provider - Home Health Agency | 8022107051 | Practice locations: Mount Vernon, IL |
National Provider Directory
- Tax ID family
- Good Samaritan Regional Health Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 1010902 | IL | Yes |
Addresses
Primary practice location
1501 McPherson Ave
Mount Vernon, IL 62864-2831
Mailing address
2 Good Samaritan Way Ste 325
Mount Vernon, IL 62864-2486
Other names
- SSM Health at Home Home Health Glen Carbon
- SSM Health at Home Home Health Mt Vernon
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Cobius Healthcare Solutions |
Other providers in Mount Vernon, IL
- Spring Garden Community Consolidated School District #178
- Spring Garden Community Consolidated School District #178
- Prateek Srinet
- SSC Mount Vernon Operating Company LLC
- SSM Health Businesses
- St. Louis JC Vamc
- Maranda Anne Stachyra
- Caleb Ryan Stanley
- Leeann Stanley
- Jennifer Lynn Starr
All providers in Mount Vernon, IL · Home Health Agency in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 1, 2023. 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.