Beacon Pace Illinois LLC

Primary specialty

PACE Provider OrganizationTaxonomy code 251T00000X

Legal business name

BEACON PACE ILLINOIS LLC

Doing business as

BoldAge PACE Illinois

Practice address

5419 135TH St
Crestwood, IL 60418-1529

Phone

(855) 801-2653

NPI assigned

Aug 14, 2024

Last updated

Jan 6, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael Czermak

Title

Chief Administrative Officer

Phone

(855) 801-2653

Specialties & licenses 1

Addresses

Other names 1

• BoldAge PACE Illinois Doing business as

Tax ID family

Beacon Pace Illinois LLC2 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.

• Beacon Pace Illinois LLC

  dba BoldAge PACE Illinois

  • PACE Provider Organization
  • Calumet City, IL
  • NPI 1073345641
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1723593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767657600000",
    "number": "1538991104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 W MOORE AVE",
            "city": "MOORESVILLE",
            "state": "NC",
            "postal_code": "281153551",
            "telephone_number": "732-806-3205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5419 135TH ST",
            "city": "CRESTWOOD",
            "state": "IL",
            "postal_code": "604181529",
            "telephone_number": "855-801-2653"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEACON PACE ILLINOIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-14",
        "last_updated": "2026-01-06",
        "certification_date": "2026-01-06",
        "status": "A",
        "authorized_official_last_name": "CZERMAK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "855-801-2653"
    },
    "taxonomies": [
        {
            "code": "251T00000X",
            "taxonomy_group": "",
            "desc": "Program of All-Inclusive Care for the Elderly (PACE) Provider Organization",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BoldAge PACE Illinois",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Axiom Terrace of Crestwood LLC
• Kevin Martin Bargamian, DMD
• Julie Barker, P.T.
• Sheila Margaret Barry, M.D./PH.D.
• Deborah A Basile, MD
• Karen Ann Beagles, PMHNP-BC
• Gina Felicia Bendoraitis
• Jessica Alexandra Benitez-Burke, PHARMD
• J. Bradford Hampshire Bertumen, M.D.
• Beyond Expectations Corp.

• PACE Provider Organization in Crestwood, IL
• Providers in Crestwood, IL by specialty
• PACE Provider Organization in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.