Active NPI
Moments Hospice of Springfield LLC
- Community Based Hospice Care Agency
- Springfield, IL
National Provider Identifier
1447941877
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- Legal business name
- MOMENTS HOSPICE OF SPRINGFIELD LLC
- Practice address
- 2131 W White Oaks Dr Ste C
Springfield, IL 62704-7416 - Phone
- (877) 666-3687
- Fax
- (763) 205-9350
- NPI assigned
- May 17, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Eliyahu Jaffa
- Title
- President
- Phone
- (715) 800-0908
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Primary |
Addresses
Primary practice location
2131 W White Oaks Dr Ste C
Springfield, IL 62704-7416
Mailing address
820 Lilac Dr N Ste 210
Golden Valley, MN 55422-4754
Phone (612) 655-5242
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240617001143 | IL | Part A Provider - Hospice | 6901349117 | Practice locations: Springfield, IL |
Hospice certification: CCN 141742
- Legal name
- MOMENTS HOSPICE OF SPRINGFIELD LLC
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Sep 11, 2024
- Last certification
- Sep 5, 2024
- Ownership / control type
- Proprietary - Partnership
- Organization structure
- LLC
- Incorporated
- Apr 25, 2023 in IL
- Enrollment address
- 2131 W White Oaks Dr
Ste C
Springfield, IL 62704-7416
Care Compare: Hospice
Medicare Care Compare- Listed as
- Moments Hospice of Springfield LLC
- Certified
- Sep 11, 2024
- Medicare certification status
- Active
National Provider Directory
National Provider DirectoryLocations
2131 W White Oaks Dr
Ste C
Springfield, IL 62704
Ownership & related parties
All disclosed owners & managing parties 8
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Shlomo Miller | 5% Or Greater Indirect Ownership Interest | Apr 25, 2023 | 32.5% |
| W-2 Managing Employee | Apr 1, 2024 | 51% | |
| Yosef Meystel | 5% Or Greater Indirect Ownership Interest | Apr 25, 2023 | 11.5% |
| Dovid Seitler | 5% Or Greater Indirect Ownership Interest | Apr 25, 2023 | 6% |
| Eliyahu Jaffa | 5% Or Greater Indirect Ownership Interest | Apr 25, 2023 | 32.5% |
| Parag K Amin | W-2 Managing Employee | Apr 1, 2024 | |
| David Berkowitz | 5% Or Greater Indirect Ownership Interest | Apr 25, 2023 | 11.5% |
| Joshua Hoffman | 5% Or Greater Indirect Ownership Interest | Apr 25, 2023 | 5% |
| MH Hold Five07 LLC | 5% Or Greater Direct Ownership Interest | Apr 25, 2023 | 100% |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
Practitioners & affiliated clinicians
Affiliated clinicians 7
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": "1684281600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1695254400000",
"number": "1447941877",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "820 LILAC DR N STE 210",
"city": "GOLDEN VALLEY",
"state": "MN",
"postal_code": "554224754",
"telephone_number": "612-655-5242"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2131 W WHITE OAKS DR STE C",
"city": "SPRINGFIELD",
"state": "IL",
"postal_code": "627047416",
"telephone_number": "877-666-3687",
"fax_number": "763-205-9350"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MOMENTS HOSPICE OF SPRINGFIELD LLC",
"organizational_subpart": "NO",
"enumeration_date": "2023-05-17",
"last_updated": "2023-09-21",
"certification_date": "2023-09-21",
"status": "A",
"authorized_official_last_name": "JAFFA",
"authorized_official_first_name": "ELIYAHU",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "715-800-0908",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Springfield, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; 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.