NPIMap

Organization Active NPI

Luther Oaks Inc

  • Skilled Nursing Facility
  • Bloomington, IL
National Provider Identifier
1639520034
Registry record updated Jun 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
LUTHER OAKS INC
Practice address
601 Lutz Rd
Bloomington, IL 61704-8608
Phone
(309) 664-5940
Fax
(309) 664-5999
NPI assigned
Jun 27, 2016
Last updated
Jun 27, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
LUTHERAN LIFE MINISTRIESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 27, 2016

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

Authorized official

Name
Roger Paulsberg
Title
President/Ceo
Phone
(847) 368-7300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

601 Lutz Rd
Bloomington, IL 61704-8608

Mailing address

601 Lutz Rd
Bloomington, IL 61704-8608
Phone (309) 664-5940

Other names 1

  • Lutheran Senior Living of Illinois Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170202001633 IL Part A Provider - Skilled Nursing Facility 8022391705 Practice locations: Bloomington, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639520034. Details of each certification follow.

Skilled nursing facility certification: CCN 146184

Legal name
LUTHER OAKS INC
Doing business as
LUTHERAN SENIOR LIVING OF ILLINOIS
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 1, 2017
Last certification
Aug 1, 2024
Beds
19
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Lutheran Life Communities
Organization structure
CorporationNon-profit
Incorporated
Mar 4, 2004 in IL
Enrollment address
601 Lutz Rd
Bloomington, IL 61704-8608
Nursing home name
LUTHER OAKS

Care Compare: Nursing home

Medicare Care Compare
Listed as
Luther OaksCCN 146184 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Oct 1, 2017
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
1917.4 residents per day on average

Processed by Care Compare on Aug 1, 2026.

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
14D2121091Luther Oaks601 Lutz Rd, Bloomington, IL 61704Certificate of waiverOct 30, 2026

National Provider Directory

National Provider Directory

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
Lutheran Life Communities Organization, Arlington Heights, IL Corporation, Non-profit Adp of the SNF Dec 1, 2012
Daniel Stephen Lau Individual Operational/Managerial Control Jan 1, 2022
Adp of the SNF Jan 1, 2022
Meredith Sloan Bentley Individual Corporate OfficerPresident/Ceo & Vice-Chair Sep 14, 2020
Adp of the SNF Sep 14, 2020
Michael Renetzky Individual Corporate OfficerChair Oct 1, 2003
Adp of the SNF Oct 1, 2003
Terri Black Individual Corporate DirectorVP of Financial Operations May 1, 2023 5%
Adp of the SNF May 1, 2023
Peter Wiedman Individual Operational/Managerial Control Dec 18, 2024
Adp of the SNF Dec 18, 2024
Old National Bank Organization, Evansville, IN Corporation, Financial institution Adp of the SNF Dec 17, 1992
Amy Lacroix Individual Corporate OfficerCoo/Secretary Oct 3, 2022
Adp of the SNF Oct 3, 2022
Thomas Management LLC Organization, Meridian, ID LLC Operational/Managerial Control Jan 1, 2022
Adp of the SNF Dec 14, 2025
Lutheran Life Ministries Organization, Arlington Heights, IL Corporation, Non-profit Adp of the SNF Dec 1, 2012
Select Rehabilitation, LLC Organization, Glenview, IL LLC Operational/Managerial Control Jan 1, 2023
Adp of the SNF Dec 4, 2025
Richter and Associates Organization, Twinsburg, OH Corporation, Consulting firm Adp of the SNF Nov 1, 2022

Owners & managing parties with NPI records 2

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

Facilities with the same owner 8

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

Practitioners & affiliated clinicians

Affiliated clinicians 2

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": "1466985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466985600000",
    "number": "1639520034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 LUTZ RD",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617048608",
            "telephone_number": "309-664-5940",
            "fax_number": "309-664-5999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 LUTZ RD",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617048608",
            "telephone_number": "309-664-5940",
            "fax_number": "309-664-5999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUTHER OAKS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LUTHERAN LIFE MINISTRIES",
        "enumeration_date": "2016-06-27",
        "last_updated": "2016-06-27",
        "status": "A",
        "authorized_official_last_name": "PAULSBERG",
        "authorized_official_first_name": "ROGER",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "847-368-7300"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lutheran Senior Living of Illinois",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Bloomington, IL

Sources for this page

Verify at the official NPI Registry.