NPIMap

Organization Active NPI

Iroquois Memorial Hospital and Resident Home

  • Home Health Agency
  • Watseka, IL
National Provider Identifier
1366447617
Registry record updated Oct 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
1006881 Issued in IL
Legal business name
IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME
Practice address
200 E Fairman Ave
Watseka, IL 60970-1644
Phone
(815) 432-6175
Fax
(815) 432-6199
NPI assigned
Jun 14, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2024

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

Authorized official

Name
Michael Tilstra
Title
Ceo
Phone
(815) 432-7777

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 1006881 IL Primary

Addresses

Primary practice location

200 E Fairman Ave
Watseka, IL 60970-1644

Mailing address

200 Laird LN
Watseka, IL 60970-7568
Phone (815) 432-6175

Other identifiers 1

IdentifierTypeStateIssuer
9975OtherILBCBS PROVIDER #

Other names 1

  • Iroquois Home Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120220000788 IL Part A Provider - Home Health Agency 4385551258 Practice locations: Watseka, IL

Home health agency certification: CCN 147586

Legal name
IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME
Doing business as
IROQUOIS HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Sep 30, 1994
Last certification
Jun 25, 2010
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
Oct 4, 1921 in IL
Enrollment address
200 Laird LN
Watseka, IL 60970-7568
HHA Branch

Other NPIs with the same Medicare PAC ID 8

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Iroquois Home HealthCCN 147586
Overall star rating
2 of 5
Ownership
Non-Profit
Certified
Sep 30, 1994
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0889688Iroquois Home Health and Iroquois Memorial Hospice200 North Laird Lane, Watseka, IL 60970Certificate of waiverAug 2, 2026

National Provider Directory

National Provider Directory
Tax ID family
Iroquois Memorial Hospi15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Michelle Fox Individual W-2 Managing Employee Sep 1, 2018
Michael Tilstra Individual Corporate OfficerPresident/Ceo Jan 17, 2022
W-2 Managing EmployeeCeo Jan 17, 2022
Daniel Tincher Individual Corporate Director Dec 27, 2021
Philip Zumwalt Individual Corporate Director Dec 15, 2021
Rhonda Pence Individual Corporate Director Jul 26, 2022
Doug Geiger Individual Corporate Director Jul 26, 2022
Roger Dittrich Individual Corporate DirectorBoard Chairman Dec 21, 2021

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 1

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": "1118707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728345600000",
    "number": "1366447617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 LAIRD LN",
            "city": "WATSEKA",
            "state": "IL",
            "postal_code": "609707568",
            "telephone_number": "815-432-6175",
            "fax_number": "815-432-6199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E FAIRMAN AVE",
            "city": "WATSEKA",
            "state": "IL",
            "postal_code": "609701644",
            "telephone_number": "815-432-6175",
            "fax_number": "815-432-6199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-14",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A",
        "authorized_official_last_name": "TILSTRA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "815-432-7777"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IL",
            "license": "1006881",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "9975",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Iroquois Home Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Iroquois Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Watseka, IL

Sources for this page

Verify at the official NPI Registry.