NPIMap

Organization Active NPI

Moments Hospice of Chicago South LLC

  • Community Based Hospice Care Agency
  • Willowbrook, IL
National Provider Identifier
1831790906
Registry record updated Sep 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
MOMENTS HOSPICE OF CHICAGO SOUTH LLC
Practice address
545 Plainfield Rd Ste G-1
Willowbrook, IL 60527-7600
Phone
(877) 666-3687
NPI assigned
Nov 5, 2020
Last updated
Sep 21, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2023

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

Authorized official

Name
Eliyahu Jaffa
Title
President
Phone
(715) 800-0908

Specialties & licenses 1

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

Addresses

Primary practice location

545 Plainfield Rd Ste G-1
Willowbrook, IL 60527-7600

Mailing address

820 Lilac Dr N Ste 210
Golden Valley, MN 55422-4754
Phone (612) 655-5242

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210920003508 IL Part A Provider - Hospice 3779980602 Practice locations: Willowbrook, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831790906. Details of each certification follow.

Hospice certification: CCN 141716

Legal name
MOMENTS HOSPICE OF CHICAGO SOUTH LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Nov 19, 2021
Last certification
Nov 19, 2021
Ownership / control type
Proprietary - Partnership
Organization structure
LLCProprietary
Incorporated
Oct 29, 2020 in IL
Enrollment address
545 Plainfield Rd
Ste G-1
Willowbrook, IL 60527-7600

Care Compare: Hospice

Medicare Care Compare
Listed as
Moments Hospice of Chicago South LLCCCN 141716 · All quality measures
Ownership
For-Profit
Certified
Nov 19, 2021
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

545 Plainfield Rd
Ste G1
Willowbrook, IL 60527
Phone (708) 405-8025

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Shlomo Miller Individual 5% Or Greater Direct Ownership Interest Oct 29, 2020 32.5%
Operational/Managerial ControlPresident Oct 29, 2020 49%
Yosef Meystel Individual 5% Or Greater Direct Ownership Interest Oct 29, 2020 11.5%
Denisa Costello Individual W-2 Managing EmployeeAd; Sep 30, 2025
Eliyahu Jaffa Individual 5% Or Greater Direct Ownership Interest Oct 29, 2020 32.5%
Corporate OfficerCeo Oct 29, 2020 51%
Parag K Amin Individual Contracted Managing EmployeeMD; Aug 1, 2024
David Berkowitz Individual 5% Or Greater Direct Ownership Interest Oct 29, 2020 11.5%
Joshua Hoffman Individual 5% Or Greater Direct Ownership Interest Oct 29, 2020 5%
Meir Meystel Individual 5% Or Greater Direct Ownership Interest Oct 29, 2020 6%
MH Hold Co LLC Organization, Golden Valley, MN LLC 5% Or Greater Direct Ownership Interest Oct 29, 2020 100%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

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.

  • Heidi Wagner
    • Family Nurse Practitioner
    • Willowbrook, IL
    • NPI 1447702147
    NPD

Affiliated clinicians 9

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

NPI Registry JSON

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

{
    "created_epoch": "1604534400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695254400000",
    "number": "1831790906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 LILAC DR N STE 210",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554224754",
            "telephone_number": "612-655-5242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 PLAINFIELD RD STE G-1",
            "city": "WILLOWBROOK",
            "state": "IL",
            "postal_code": "605277600",
            "telephone_number": "877-666-3687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOMENTS HOSPICE OF CHICAGO SOUTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-11-05",
        "last_updated": "2023-09-21",
        "certification_date": "2023-09-21",
        "status": "A",
        "authorized_official_last_name": "JAFFA",
        "authorized_official_first_name": "ELIYAHU",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "715-800-0908"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willowbrook, IL

Sources for this page

Verify at the official NPI Registry.