NPIMap

Organization Active NPI

Dover Hospice Il STL Metro, LLC

  • Community Based Hospice Care Agency
  • Glen Carbon, IL
National Provider Identifier
1629822358
Registry record updated Apr 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
DOVER HOSPICE IL STL METRO, LLC
Practice address
2 Ginger CRK
Glen Carbon, IL 62034-3413
Phone
(573) 760-3730
NPI assigned
Apr 17, 2024
Last updated
Apr 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2024

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

Authorized official

Name
Brandy Pratt, RN, MSN
Title
Vice President
Phone
(573) 760-3730

Specialties & licenses 1

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

Addresses

Primary practice location

2 Ginger CRK
Glen Carbon, IL 62034-3413

Mailing address

300 Hunter Ave Ste 200
Saint Louis, MO 63124-2328
Phone (314) 884-8817

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250625003071 IL Part A Provider - Hospice 4183136070 Practice locations: Glen Carbon, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629822358. Details of each certification follow.

Hospice certification: CCN 141745

Legal name
DOVER HOSPICE IL STL METRO, LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Aug 14, 2025
Last certification
Aug 7, 2025
Ownership / control type
Proprietary - Other
Organization structure
LLCProprietary
Enrollment address
2 Ginger Creek VLG
Glen Carbon, IL 62034-3517

Care Compare: Hospice

Medicare Care Compare
Listed as
Dover Hospice Il STL Metro, LLCCCN 141745 · All quality measures
Certified
Aug 14, 2025
Medicare certification status
ActiveFrom the Provider of Services file

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
14D2308268Dover Hospice Il STL Metro, LLC2 Ginger Creek Village, Glen Carbon, IL 62034Certificate of waiverJul 23, 2026

National Provider Directory

National Provider Directory

Locations

2 Ginger Creek Vlg
Glen Carbon, IL 62034
Phone (618) 961-8331

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Dover Hospice, LLC Organization, Saint Louis, MO LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Oct 30, 2023 100%
Dover Holdings Management, LLC Organization, Saint Louis, MO Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 2025 31%
Dover Holdings, LLC - Dover Health Organization, Saint Louis, MO LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Oct 30, 2023 31%
Dover Health Holdings, LLC Organization, Saint Louis, MO LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Oct 30, 2023 98%
Stephen Wertman Individual 5% Or Greater Indirect Ownership Interest Oct 30, 2023 7.5%
Dover Health, LLC Organization, Saint Louis, MO LLC, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Oct 30, 2023 98%
Andrew Mahtani Individual Contracted Managing EmployeeMD; Jul 15, 2024
Dover Capital Management Organization, Saint Louis, MO Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Oct 1, 2024 50%
Joshua Jennings Individual OtherPlease See Below for Title Info Oct 23, 2023
Fred Grossman Individual Corporate OfficerChief Financial Officer Jun 16, 2025
Almir Sajtovic Individual 5% Or Greater Indirect Ownership Interest Oct 30, 2023 7.5%
Ronald Page Belongy Individual W-2 Managing EmployeeAd; May 31, 2024 50%
Operational/Managerial Control May 31, 2024 50%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 4

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": "1713312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713312000000",
    "number": "1629822358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 HUNTER AVE STE 200",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631242328",
            "telephone_number": "314-884-8817"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 GINGER CRK",
            "city": "GLEN CARBON",
            "state": "IL",
            "postal_code": "620343413",
            "telephone_number": "573-760-3730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOVER HOSPICE IL STL METRO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-04-17",
        "last_updated": "2024-04-17",
        "certification_date": "2024-04-17",
        "status": "A",
        "authorized_official_last_name": "PRATT",
        "authorized_official_first_name": "BRANDY",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "573-760-3730",
        "authorized_official_credential": "RN, MSN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glen Carbon, IL

Sources for this page

Verify at the official NPI Registry.