NPIMap

Organization Active NPI

Hospice of Southern Illinois, Inc.

  • Community Based Hospice Care Agency
  • Belleville, IL
National Provider Identifier
1720081805
Registry record updated Oct 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
2000115 Issued in IL
Legal business name
HOSPICE OF SOUTHERN ILLINOIS, INC.
Practice address
305 S Illinois St
Belleville, IL 62220-2133
Phone
(618) 235-1703
Fax
(618) 235-3130
NPI assigned
May 23, 2005
Last updated
Oct 5, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2015

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

Authorized official

Name
Mrs. Rebecca J Wisdom, LCSW
Title
President & Ceo
Phone
(618) 235-1703

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 2000115 IL Primary

Addresses

Primary practice location

305 S Illinois St
Belleville, IL 62220-2133

Mailing address

305 S Illinois St
Belleville, IL 62220-2133
Phone (618) 235-1703

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120409000690 IL Part A Provider - Hospice 9537167499 Practice locations: Belleville, IL; Marion, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720081805. Details of each certification follow.

Hospice certification: CCN 141504

Legal name
HOSPICE OF SOUTHERN ILLINOIS, INC.
Certification status
Active
Provider type (POS)
Hospice
Participating since
Aug 1, 1984
Last certification
Sep 3, 2020
Ownership / control type
Non-Profit - Private
Organization structure
CorporationNon-profit
Incorporated
Jul 14, 1981 in IL
Enrollment address
305 South Illinois Street
Belleville, IL 62220-2159

Care Compare: Hospice

Medicare Care Compare
Listed as
Hospice of Southern Illinois, IncCCN 141504 · All quality measures
Ownership
Non-Profit
Certified
Aug 1, 1984
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

305 S Illinois St
Belleville, IL 62220
Phone (618) 235-1703

333 S Illinois St
Belleville, IL 62220
Phone (618) 235-1703

204 Halfway Rd
Marion, IL 62959
Phone (618) 997-3030

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Elaine a Matzenbacher Individual Corporate Officer Sep 18, 2017
W-2 Managing Employee Sep 18, 2017
Amy Richter Individual Corporate OfficerPresident and Ceo Dec 14, 2009
W-2 Managing EmployeeAd; Dec 14, 2009
Amy L Rohlfing Individual Corporate DirectorMedical Director Apr 21, 2025
W-2 Managing EmployeeAd;MD; Apr 21, 2025
Floria Densmore Individual Corporate OfficerCco Sep 9, 2013
W-2 Managing Employee Sep 9, 2013
Hospice of Southern Illinois, Inc. Organization, Belleville, IL Non-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2022

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 7

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.

Affiliated clinicians 115

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

View all 115

NPI Registry JSON

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444003200000",
    "number": "1720081805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 S ILLINOIS ST",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622202133",
            "telephone_number": "618-235-1703",
            "fax_number": "618-235-3130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 S ILLINOIS ST",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622202133",
            "telephone_number": "618-235-1703",
            "fax_number": "618-235-3130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPICE OF SOUTHERN ILLINOIS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-23",
        "last_updated": "2015-10-05",
        "status": "A",
        "authorized_official_last_name": "WISDOM",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "618-235-1703",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "IL",
            "license": "2000115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Belleville, IL

Sources for this page

Verify at the official NPI Registry.