NPIMap

Organization Active NPI

Riverside Medical Center

  • Home Health Agency
  • Peotone, IL
National Provider Identifier
1740346451
Registry record updated Sep 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
1001668 Issued in 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
Last updated
Sep 30, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
RIVERSIDE MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 30, 2019

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

Authorized official

Name
Mr. Bill Douglas
Title
Cfo
Phone
(815) 935-7256

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 1001668 IL Primary

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090929000566 IL Part A Provider - Home Health Agency 5991608549 Practice locations: Peotone, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1740346451. Details of each certification follow.

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
CorporationNon-profit
Incorporated
May 20, 1959 in IL
Enrollment address
611 Division St
Peotone, IL 60468-9590

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
R.M.C. Home Health CareCCN 147400 · All quality measures
Overall star rating
3.5 of 5
Ownership
Non-Profit
Certified
Jan 16, 1985
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Riverside Medical Cente13 organizations share this tax ID, including this one
Part of
Riverside Medical Cente

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

23120 S Lagrange Rd
Ste 100
Frankfort, IL 60423
Phone (815) 935-3322

1905 W Court St
Kankakee, IL 60901
Phone (815) 933-2240

1905 W Court St
#D
Kankakee, IL 60901

500 N Wall St
Ste 400
Kankakee, IL 60901
Phone (815) 933-6526

395 N Locust St
Manteno, IL 60950
Phone (815) 468-6870

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Francis Smith Individual Corporate DirectorBoard Member Jan 1, 2012
Lisa Dugan Individual Corporate DirectorBoard Member Jan 1, 2012
Bill W. Douglas Individual W-2 Managing EmployeeCfo Sep 4, 2009
Marc L Fisher Individual Corporate DirectorBoard Member Jan 1, 2012
Nadeem Ansari Individual Corporate DirectorBoard Member Jan 1, 2012
Phillip M. Kambic Individual W-2 Managing Employee Aug 14, 2009
Patricia K Vilt Individual Corporate OfficerSenior Vice President Oct 25, 2019
W-2 Managing EmployeeSenior Vice President Oct 25, 2019
Connie B Ashline Individual Corporate DirectorBoard Member Jan 1, 2012
Richard P Schiltz Individual W-2 Managing EmployeeDirector of Finance Sep 4, 2009
Harry Simmon Individual Corporate DirectorBoard Member Jan 1, 2012
Stonewall McCuiston Individual Corporate DirectorBoard Member Jan 1, 2012

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Miller Health Care CenterKankakee, IL, CCN 145843 Skilled nursing facility Operational/Managerial Control Jan 1, 2024

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 10

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 50

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

View all 50

NPI Registry JSON

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569801600000",
    "number": "1740346451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 N WALL ST",
            "city": "KANKAKEE",
            "state": "IL",
            "postal_code": "609012901",
            "telephone_number": "815-933-1671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 DIVISION STREET",
            "city": "PEOTONE",
            "state": "IL",
            "postal_code": "604689590",
            "telephone_number": "815-935-3272",
            "fax_number": "815-937-7961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RIVERSIDE MEDICAL CENTER",
        "enumeration_date": "2006-12-28",
        "last_updated": "2019-09-30",
        "status": "A",
        "authorized_official_last_name": "DOUGLAS",
        "authorized_official_first_name": "BILL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "815-935-7256",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IL",
            "license": "1001668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peotone, IL

Sources for this page

Verify at the official NPI Registry.