Prairie Healthcare Services LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

PRAIRIE HEALTHCARE SERVICES LLC

Practice address

5920 Hohman Av
Hammond, IN 46320

Phone

(219) 240-1246

Fax

(219) 240-1246

NPI assigned

Oct 20, 2017

Organization subpart

No

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

Authorized official

Name

Mr. Shahzad Khan

Title

Ceo

Phone

(219) 240-1246

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Home health agency certification: CCN 157710

Legal name

PRAIRIE HEALTHCARE SERVICES LLC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Apr 16, 2020

Last certification

Apr 16, 2020

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Incorporated

Sep 12, 2017 in IN

Enrollment address

5920 Hohman Ave
Hammond, IN 46320-2423

Listed as

Prairie Healthcare Services LLCCCN 157710 · All quality measures

Overall star rating

1.5 of 5

Ownership

Proprietary

Certified

Apr 16, 2020

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Physical therapy, Speech pathology, Occupational therapy

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 1

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

Affiliated clinicians 2

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

• Pratima Dhakal, FNP

  • Family Nurse Practitioner
  • South Bend, IN
  • NPI 1619447976

  Home health agency

  Care Compare affiliation
• Anto Varghese Maliakkal, M.D. H.M.D.C

  • Internal Medicine Physician
  • Burr Ridge, IL
  • NPI 1558376368

  Home health agency

  Care Compare affiliation

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

{
    "created_epoch": "1508457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1700397478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5920 HOHMAN AVE",
            "city": "HAMMOND",
            "state": "IN",
            "postal_code": "463202423",
            "telephone_number": "219-240-1246",
            "fax_number": "219-240-1246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5920 HOHMAN AV",
            "city": "HAMMOND",
            "state": "IN",
            "postal_code": "46320",
            "telephone_number": "219-240-1246",
            "fax_number": "219-240-1246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE HEALTHCARE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-20",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "SHAHZAD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "219-240-1246",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kayla Polen
• Restina Polovic, R.PH.
• Patrick A Pontee, MD
• Dale Poortenga, FNP
• Amanda Rose Popovich
• Premise Health of Indiana Medical PC (Caesars Health Center Hammond)
• Brittany Press, RN
• Pro Dental in 1 PC (Destiny Dental of Hammond)
• Diego Puentez
• Purdue University (Purdue University Calumet Student Health Center)

• Home Health Agency in Hammond, IN
• Providers in Hammond, IN by specialty
• Home Health Agency in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.

Verify at the official NPI Registry.