Riverside Medical Center
Organization Active NPI Home Health Agency · Peotone, IL
NPI 1740346451 · NPPES record last updated Sep 30, 2019
Key facts
- NPI
- 1740346451
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- 1001668 (IL)
- Legal business name
- RIVERSIDE MEDICAL CENTER
- Practice address
- 611 Division Street
Peotone, IL 60468-9590 - Phone
- (815) 935-3272
- Fax
- (815) 937-7961
- NPI assigned
- Dec 28, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- RIVERSIDE MEDICAL CENTER
Authorized official
- Name
- Mr. Bill Douglas
- Title
- Cfo
- Phone
- (815) 935-7256
Owners & managing parties with NPI records 3
-
Nadeem Ansari, MD
-
Marc L Fisher, M.D.
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 12
Member organizations 2
Practitioners 10
-
Nicholas Cundari, RD
-
Kathleen Kleinert, RD, LDN
-
Nadeem Ansari, MD
-
Vanessa L Capps, FNP-BC
-
Marc L Fisher, M.D.
-
Philip G Hays, M.D
-
Mehmet Sipahi, MD
Affiliated clinicians 50
-
Dharam R Anand, M.D.
-
Nadeem Ansari, MD
-
Davina Monique Betts, PA-C
-
Sean Alexander Burress, MSN FNP-BC
-
Jenna M Cella, D.O.
-
Naresh C Chandan, DO
-
Ritu Chandan, D.O.
-
Sanjay Chatrath, DO
-
Erin Renae Dean, FNP-BC
-
Elizabeth D. Deck, FNP-BC
-
Joehar Hamdan, DO
-
Tammie Henderson, N.P.
-
Asima K Hussaini, MD
-
Joanna L. Lambert, FNP-BC
-
Jeffery Long, MD
-
Niby Mathew, M.D.
Medicare Care Compare: Home health agency
- Listed as
- R.M.C. Home Health Care
- Overall star rating
- ★★★★☆ 3.5 of 5
- Ownership
- Non-Profit
- Certified
- Jan 16, 1985
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Home health agency certification: CCN 147400
- Legal name
- RIVERSIDE MEDICAL CENTER
- Doing business as
- RIVERSIDE MEDICAL CENTER HOME HEALTH CARE
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Jan 16, 1985
- Last certification
- Oct 19, 2012
- Ownership / control type
- Non-Profit
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 20, 1959 in IL
- Enrollment address
- 611 Division St
Peotone, IL 60468-9590
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Francis Smith |
Corporate Director |
Jan 1, 2012 | |
| Lisa Dugan |
Corporate Director |
Jan 1, 2012 | |
| Bill W. Douglas |
W-2 Managing Employee |
Sep 4, 2009 | |
| Marc L Fisher |
Corporate Director |
Jan 1, 2012 | |
| Nadeem Ansari |
Corporate Director |
Jan 1, 2012 | |
| Phillip M. Kambic |
W-2 Managing Employee | Aug 14, 2009 | |
| Patricia K Vilt |
Corporate Officer |
Oct 25, 2019 | |
| W-2 Managing Employee |
Oct 25, 2019 | ||
| Connie B Ashline |
Corporate Director |
Jan 1, 2012 | |
| Richard P Schiltz |
W-2 Managing Employee |
Sep 4, 2009 | |
| Harry Simmon |
Corporate Director |
Jan 1, 2012 | |
| Stonewall McCuiston |
Corporate Director |
Jan 1, 2012 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Miller Health Care Center |
Skilled nursing facility | Operational/Managerial Control | Jan 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090929000566 | IL | Part a Provider - Home Health Agency | 5991608549 | Practice locations: Peotone, IL |
National Provider Directory
- Tax ID family
- Pembroke Clinic
- Part of
- Pembroke Clinic
Locations
400 Riverside Dr
Bourbonnais, IL 60914
Phone (815) 802-7560
85 E Burns Rd
Bourbonnais, IL 60914
Phone (815) 935-3332
100 Riverside Dr
Bourbonnais, IL 60914
Phone (815) 802-7090
400 S Kennedy Dr
Ste 200
Bradley, IL 60915
Phone (815) 933-0007
23120 S Lagrange Rd
Ste 100
Frankfort, IL 60423
Phone (815) 935-3322
350 N Wall St
Kankakee, IL 60901
Phone (815) 935-7500
1905 W Court St
#D
Kankakee, IL 60901
500 N Wall St
Ste 400
Kankakee, IL 60901
Phone (815) 933-6526
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 1001668 | IL | Yes |
Addresses
Primary practice location
611 Division Street
Peotone, IL 60468-9590
Mailing address
350 N Wall St
Kankakee, IL 60901-2901
Phone (815) 933-1671
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 50482 | Other | IL | BLUE CROSS BLUE SHIELD |
| MW10893 | Other | IL | MEDICARE ELECTRONIC NUMBE |
| 216396 | Other | IL | PERSONAL CARE |
Other providers in Peotone, IL
- Paige Julia Nooner
- Arthur B. Pasquinelli
- Peotone Community Unit School District #207-U
- Tabitha Peppmuller
- Candy Quinn
- Kimberly Karen Roediger
- Scott R Lowry DO 2, LLC
- Madilyn Abigail Seyller
- Bria Stubblefield
- Teske Family Chiropractic Center LTD
All providers in Peotone, IL · Home Health Agency in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 30, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.