NPIMap

Organization Active NPI

Henderson County

Doing business as Henderson County Health Department Hospice

  • Community Based Hospice Care Agency
  • Gladstone, IL
National Provider Identifier
1437425378
Registry record updated Feb 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
2002640 Issued in IL
Legal business name
HENDERSON COUNTY
Doing business as
Henderson County Health Department Hospice
Practice address
208 W Elm St
Gladstone, IL 61437-5028
Phone
(309) 627-2812
Fax
(309) 627-2305
NPI assigned
Mar 26, 2012
Last updated
Feb 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2024

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

Authorized official

Name
Diana Seitz
Title
Office Manager
Phone
(309) 627-2812

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 2002640 IL Primary

Addresses

Primary practice location

208 W Elm St
Gladstone, IL 61437-5028

Mailing address

PO Box 220
Gladstone, IL 61437-0220
Phone (309) 627-2812

Other names 1

  • Henderson County Health Department Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080123000772 IL Part A Provider - Hospice 2466534938 1 other NPI on this enrollment
Practice locations: Gladstone, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437425378. Details of each certification follow.

Hospice certification: CCN 141631

Legal name
HENDERSON COUNTY
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 11, 2009
Last certification
Oct 1, 2020
Ownership / control type
Government - County
Organization structure
GovernmentProprietary
Enrollment address
208 W Elm St
Gladstone, IL 61437-5028

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospice

Medicare Care Compare
Listed as
Henderson County Health Department HospiceCCN 141631 · All quality measures
Ownership
Combination Government & Non-Profit
Certified
Jun 11, 2009
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Henderson County2 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.

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Henderson County Organization, Gladstone, IL Operational/Managerial Control Aug 29, 2007
Diana Seitz Individual Operational/Managerial ControlOffice Manager Home Health and H Jun 21, 2022
Frank T Lasala Individual Corporate DirectorBoard Member Apr 24, 2013
Tom Pullen Individual Corporate DirectorBoard Member Apr 12, 2012
Judy Gravgaard Individual Corporate DirectorBoard President Aug 9, 2011
W-2 Managing Employee Dec 1, 2013
Marilyn Simmons Individual Corporate DirectorBoard Member Aug 9, 2011
Carol Elsea Individual Corporate DirectorBoard Member May 19, 2010
Brian Good Individual Corporate DirectorBoard Member Aug 29, 2007
Jim Alexander Individual Corporate DirectorBoard Member Jan 10, 2013

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Simitree BillingGladstone, IL, CCN 147178 Home health agency 5% Or Greater Direct Ownership Interest (100%) Aug 1, 1978

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Henderson County
    • Home Health Agency
    • Gladstone, IL
    • NPI 1821001595

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

    CMS ownership

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

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": "1332720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708387200000",
    "number": "1437425378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 220",
            "city": "GLADSTONE",
            "state": "IL",
            "postal_code": "614370220",
            "telephone_number": "309-627-2812",
            "fax_number": "309-627-2305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "208 W ELM ST",
            "city": "GLADSTONE",
            "state": "IL",
            "postal_code": "614375028",
            "telephone_number": "309-627-2812",
            "fax_number": "309-627-2305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENDERSON COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-26",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A",
        "authorized_official_last_name": "SEITZ",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "309-627-2812"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "IL",
            "license": "2002640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Henderson County Health Department Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Henderson County Health Department Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gladstone, IL

Sources for this page

Verify at the official NPI Registry.