NPIMap

Organization Active NPI

Residential Clinical Services, Inc.

  • Home Health Agency
  • Merrillville, IN
National Provider Identifier
1376549410
Registry record updated Aug 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
04-005307-1 Issued in IN
Legal business name
RESIDENTIAL CLINICAL SERVICES, INC.
Practice address
8102 Georgia St FL 2
Merrillville, IN 46410-6225
Phone
(219) 736-5718
Fax
(219) 736-5720
NPI assigned
Jun 23, 2005
Last updated
Aug 13, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2021

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

Authorized official

Name
Dr. Ahmed A. Mohamed, DPTNPI 1801805148
Title
Administrator/President
Phone
(219) 736-5718

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 04-005307-1 IN Primary

Addresses

Primary practice location

8102 Georgia St FL 2
Merrillville, IN 46410-6225

Mailing address

103 W 78TH PL
Merrillville, IN 46410-5468
Phone (219) 736-5718

Other identifiers 5

IdentifierTypeStateIssuer
1022733OtherINUNITED HEALTHCARE
079775500OtherINUS DEPT. OF LABOR
000000097953OtherINANTHEM
50393OtherINBCBS OF ILLINOIS
100263870MedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100324000462 IN Part A Provider - Home Health Agency 6305971771 Practice locations: Merrillville, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1376549410. Details of each certification follow.

Home health agency certification: CCN 157116

Legal name
RESIDENTIAL CLINICAL SERVICES, INC.
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Apr 10, 1984
Last certification
Sep 15, 2021
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Incorporated
Jun 17, 1986 in IN
Enrollment address
8102 Georgia St
Merrillville, IN 46410-6225

Care Compare: Home health agency

Medicare Care Compare
Listed as
Residential Clinical Services IncCCN 157116 · All quality measures
Overall star rating
2.5 of 5
Ownership
Proprietary
Certified
Apr 10, 1984
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
15D0647343Residential Clinical Services Inc8102 Georgia Street, Merrillville, IN 46410Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

103 W 78th Pl
Merrillville, IN 46410

8102 Georgia St
Fl 2
Merrillville, IN 46410
Phone (219) 736-5718

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Sayed H Yousef Individual 5% Or Greater Direct Ownership Interest Aug 31, 2014 25%
Corporate Director Aug 31, 2014 25%
Moatzz Mohamed Individual 5% Or Greater Direct Ownership Interest Aug 31, 2014 25%
Ahmed Mohamed Individual 5% Or Greater Direct Ownership Interest Aug 31, 2014 25%
Corporate Officer Aug 31, 2014 25%
W-2 Managing Employee Aug 31, 2014 100%
Khaled Gad Individual 5% Or Greater Direct Ownership Interest Aug 31, 2014 25%

Owners & managing parties with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 6

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": "1119484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628812800000",
    "number": "1376549410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 W 78TH PL",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464105468",
            "telephone_number": "219-736-5718",
            "fax_number": "219-736-5720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8102 GEORGIA ST FL 2",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464106225",
            "telephone_number": "219-736-5718",
            "fax_number": "219-736-5720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESIDENTIAL CLINICAL SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-23",
        "last_updated": "2021-08-13",
        "certification_date": "2021-08-13",
        "status": "A",
        "authorized_official_last_name": "MOHAMED",
        "authorized_official_first_name": "AHMED",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "ADMINISTRATOR/PRESIDENT",
        "authorized_official_telephone_number": "219-736-5718",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IN",
            "license": "04-005307-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "1022733",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPT. OF LABOR",
            "identifier": "079775500",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000097953",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF ILLINOIS",
            "identifier": "50393",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100263870",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Merrillville, IN

Sources for this page

Verify at the official NPI Registry.