NPIMap

Organization Active NPI

Kishwaukee Community Hospital

Doing business as Northwestern Medicine Kishwaukee Hospital

  • General Acute Care Hospital
  • Dekalb, IL
National Provider Identifier
1669534517
Registry record updated Jul 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
KISHWAUKEE COMMUNITY HOSPITAL
Doing business as
Northwestern Medicine Kishwaukee Hospital
Practice address
1 Kish Hospital Dr
Dekalb, IL 60115-9602
Phone
(815) 756-1521
NPI assigned
Dec 15, 2006
Last updated
Jul 2, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2024

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

Authorized official

Name
Maura O'Toole
Title
President
Phone
(815) 766-7940

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X IL Primary

Addresses

Primary practice location

1 Kish Hospital Dr
Dekalb, IL 60115-9602

Mailing address

Dept. 4698
Carol Stream, IL 60122-4698
Phone (815) 756-1521

Other identifiers 2

IdentifierTypeStateIssuer
0059OtherILIL BLUE CROSS INPATIENT
003659OtherHEALTH ALLIANCE

Other names 1

  • NORTHWESTERN MEDICINE KISHWAUKEE HOSPITAL Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.cms.gov/research-statistics-data-systems/electronic-submission-medicaldocumentation-esmd/cms-health-information-handler Other CMS HIH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070515000162 IL Part A Provider - Hospital 7012813348 Practice locations: Dekalb, IL; Sycamore, IL; Hampshire, IL; Genoa, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669534517. Details of each certification follow.

Hospital certification: CCN 140286

Legal name
KISHWAUKEE COMMUNITY HOSPITAL
Doing business as
NORTHWESTERN MEDICINE KISHWAUKEE HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Dec 21, 1975
Last certification
Oct 4, 2018
Beds
98
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Feb 25, 1970 in IL
Enrollment address
1 Kish Hospital Dr
Dekalb, IL 60115-9602
Main/Primary Hospital Location
Hospital subgroups
General, Acute care

Care Compare: Hospital

Medicare Care Compare
Listed as
Northwestern Medicine Kishwaukee HospitalCCN 140286 · All quality measures
Overall star rating
5 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member organizations 3

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 29

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

NameRoleSinceShare
Anthony K Kesman Individual Corporate DirectorBoard Member Sep 1, 2022
Jose Carlos Gonzalez-Mendez Individual Corporate DirectorBoard Member Sep 1, 2018
Kishhealth System Organization, Dekalb, IL Corporation 5% Or Greater Direct Ownership Interest Feb 25, 1970 100%
Bahram Ghaderi Individual Corporate DirectorBoard Member Sep 1, 2025
James Zallie Individual Corporate DirectorBoard Member Sep 1, 2022
Michael J Leonard Individual Corporate DirectorBoard Member Sep 1, 2022
Carol L Bernick Individual Corporate DirectorBoard Member Sep 1, 2022
Beatrice Correa Rivera Individual Corporate DirectorBoard Member Jun 22, 2025
Ikechukwu I Chineme Individual Corporate DirectorBoard Member Sep 1, 2025
Michael J Mullen Individual Corporate DirectorRevenue Cycle West Reg Sep 1, 2022
Aaron S Epstein Individual Corporate DirectorBoard Member Sep 1, 2024
John J Guido Individual Corporate Director Jan 1, 2024
Dean M Harrison Individual Corporate DirectorBoard Member Dec 1, 2015
Kermit R Crawford Individual Corporate DirectorBoard Member Sep 1, 2022
Howard B Chrisman Individual Corporate DirectorBoard Member Jan 1, 2023
Thomas a Carey Individual Corporate DirectorBoard Member Sep 1, 2022
William P Flesch Individual Corporate DirectorBoard Member Sep 1, 2022
Michele C Montpetit Individual Corporate DirectorBoard Member Sep 1, 2024
Charles Ruth Individual Corporate DirectorBoard Member Sep 1, 2022
Joseph R Crane Individual Corporate DirectorBoard Member Sep 1, 2022
Scott P Serota Individual Corporate DirectorBoard Member Sep 1, 2022
Forrest R Whittaker Individual Corporate DirectorBoard Member Sep 1, 2022
James Thorpe Individual Corporate DirectorBoard Member Sep 1, 2022
Northwestern Memorial Healthcare Organization, Chicago, IL Corporation, Holding company, Non-profit 5% Or Greater Indirect Ownership Interest Dec 1, 2015 100%
Kevin Poorten Individual Corporate DirectorBoard Member Mar 1, 2022
Scott L Gwilliam Individual Corporate DirectorBoard Member Sep 1, 2022
Stephen L Davis Individual Corporate DirectorBoard Member Sep 1, 2018
Maura O'Toole Individual Corporate OfficerPresident Dec 1, 2021
Corporate DirectorBoard Member Dec 1, 2021
W-2 Managing EmployeePresident Dec 1, 2021
Deborah S Saran Individual Corporate DirectorBoard Member Sep 1, 2022

Owners & managing parties with NPI records 6

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

Facilities with the same owner 13

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

View all 13

Practitioners & affiliated clinicians

Practitioners 29

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 29

Affiliated clinicians 679

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 679

NPI Registry JSON

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719878400000",
    "number": "1669534517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT. 4698",
            "city": "CAROL STREAM",
            "state": "IL",
            "postal_code": "601224698",
            "telephone_number": "815-756-1521",
            "fax_number": "815-748-8337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 KISH HOSPITAL DR",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601159602",
            "telephone_number": "815-756-1521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KISHWAUKEE COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2024-07-02",
        "certification_date": "2023-06-15",
        "status": "A",
        "authorized_official_last_name": "O'TOOLE",
        "authorized_official_first_name": "MAURA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-766-7940"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL BLUE CROSS INPATIENT",
            "identifier": "0059",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "003659",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.cms.gov/research-statistics-data-systems/electronic-submission-medicaldocumentation-esmd/cms-health-information-handler",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.13.34.110.1.998.01",
            "affiliationName": "CMS HIH",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "7500 Security Blvd",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212441849",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "NORTHWESTERN MEDICINE KISHWAUKEE HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dekalb, IL

Sources for this page

Verify at the official NPI Registry.