NPIMap

Organization Active NPI

St. Bernard Hospital

  • General Acute Care Hospital
  • Chicago, IL
National Provider Identifier
1811034291
Registry record updated Sep 10, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
0002303 Issued in IL
Legal business name
ST. BERNARD HOSPITAL
Practice address
326 W 64TH St
Chicago, IL 60621-3114
Phone
(773) 962-4100
Fax
(773) 962-9276
NPI assigned
Feb 1, 2007
Last updated
Sep 10, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2010

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

Authorized official

Name
Mr. Guy Richard Alton, CPA
Title
Chief Financial Officer
Phone
(773) 962-4073

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 0002303 IL Primary

Addresses

Primary practice location

326 W 64TH St
Chicago, IL 60621-3114

Mailing address

326 W 64TH St
Chicago, IL 60621-3114
Phone (773) 962-4100

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100811000087 IL Part A Provider - Hospital 1759361579 Practice locations: Chicago, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811034291. Details of each certification follow.

Hospital certification: CCN 140103

Legal name
ST BERNARD HOSPITAL
Doing business as
ST. BERNARD HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Feb 2, 2022
Beds
210
Ownership / control type
Church
Organization structure
CorporationNon-profit
Incorporated
Apr 27, 1904 in IL
Enrollment address
326 W 64TH St
Chicago, IL 60621-3114
Other Hospital Practice Location
Hospital subgroups
Acute care

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
St Bernard HospitalCCN 140103 · All quality measures
Overall star rating
1 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
St Bernard Emerg Physic13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

6307 S Stewart Ave
Chicago, IL 60621
Phone (773) 776-8800

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Charles a Holland Individual Corporate OfficerPresident/Ceo Jan 2, 2013
Operational/Managerial ControlPresident/Ceo Jan 2, 2013 100%
George S Dengler Individual Corporate DirectorTrustee Mar 1, 2018
St Bernard Hospital Organization, Chicago, IL Non-profit 5% Or Greater Direct Ownership Interest Jul 14, 2010 100%
Olalekan O Sowade Individual Corporate OfficerVice Chair & Treasurer Mar 1, 2019
Mary Pokorny Individual Corporate OfficerSecretary Mar 1, 2021
Gerald Dew Individual Corporate DirectorTrustee Mar 1, 2021
Elizabeth Vanstraten Individual Corporate DirectorTrustee Jan 1, 2010
Joanne Delehanty Individual Corporate DirectorTrustee Jan 1, 2010
Patricia Merryweather-Arges Individual Corporate OfficerChairperson of the Board Mar 1, 2021
Carol Collum Individual Corporate DirectorTrustee Mar 1, 2021
Daria B Terrell Individual Corporate DirectorTrustee Mar 1, 2022
Felicia Slaton-Young Individual Corporate DirectorTrustee Mar 1, 2021
Michael Cleavenger Individual Corporate DirectorTrustee Mar 1, 2017
Raj Kumar Khurana Individual Corporate DirectorTrustee Mar 1, 2018

Owners & managing parties with NPI records 5

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

Practitioners & affiliated clinicians

Affiliated clinicians 119

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

View all 119

NPI Registry JSON

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284076800000",
    "number": "1811034291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "326 W 64TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606213114",
            "telephone_number": "773-962-4100",
            "fax_number": "773-962-9276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "326 W 64TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606213114",
            "telephone_number": "773-962-4100",
            "fax_number": "773-962-9276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. BERNARD HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2010-09-10",
        "status": "A",
        "authorized_official_last_name": "ALTON",
        "authorized_official_first_name": "GUY",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "773-962-4073",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "IL",
            "license": "0002303",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.