NPIMap

Organization Active NPI

Iroquois Memorial Hospital and Resident Home

  • Community Based Hospice Care Agency
  • Watseka, IL
National Provider Identifier
1841295763
Registry record updated May 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
2002400 Issued in IL
Legal business name
IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME
Practice address
200 E Fairman Ave
Watseka, IL 60970-1644
Phone
(815) 432-0185
Fax
(815) 432-6199
NPI assigned
Jun 16, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 29, 2026

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

Authorized official

Name
Michael Tilstra
Title
Ceo
Phone
(815) 432-7777

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Family Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QH0002X
Community Based Hospice Care Agency 251G00000X 2002400 IL Primary

Addresses

Primary practice location

200 E Fairman Ave
Watseka, IL 60970-1644

Mailing address

200 E Fairman Ave
Watseka, IL 60970-1644
Phone (815) 432-0185

Other identifiers 1

IdentifierTypeStateIssuer
50344OtherILBCBS PROVIDER #

Other names 1

  • Iroquois Memorial Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040920000977 IL Part A Provider - Hospice 4385551258 Practice locations: Watseka, IL

Hospice certification: CCN 141616

Legal name
IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME
Doing business as
IROQUOIS MEMORIAL HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Nov 4, 2004
Last certification
Nov 5, 2004
Ownership / control type
Other
Organization structure
CorporationNon-profit
Incorporated
Oct 4, 1921 in IL
Enrollment address
200 E Fairman Ave
Watseka, IL 60970-1644

Other NPIs with the same Medicare PAC ID 8

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Iroquois Memorial HospiceCCN 141616
Ownership
Other
Certified
Nov 4, 2004
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Iroquois Memorial Hospi15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Michelle Fox Individual W-2 Managing Employee Sep 1, 2018
Michael Tilstra Individual Corporate Director Feb 17, 2022
Daniel Tincher Individual Corporate Director Feb 1, 2010
Sara J Mikuta Individual Corporate Director Dec 28, 2021
Philip Zumwalt Individual Corporate Director Feb 1, 2010
Rhonda Pence Individual Corporate DirectorBoard Chair Feb 1, 2014
Mitchell Haas Individual W-2 Managing Employee Sep 1, 2023
Roger Dittrich Individual Corporate Officer Sep 28, 2010

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 11

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": "1118880000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780012800000",
    "number": "1841295763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E FAIRMAN AVE",
            "city": "WATSEKA",
            "state": "IL",
            "postal_code": "609701644",
            "telephone_number": "815-432-0185",
            "fax_number": "815-432-6199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 E FAIRMAN AVE",
            "city": "WATSEKA",
            "state": "IL",
            "postal_code": "609701644",
            "telephone_number": "815-432-0185",
            "fax_number": "815-432-6199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IROQUOIS MEMORIAL HOSPITAL AND RESIDENT HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-16",
        "last_updated": "2026-05-29",
        "certification_date": "2026-05-29",
        "status": "A",
        "authorized_official_last_name": "TILSTRA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "815-432-7777"
    },
    "taxonomies": [
        {
            "code": "207QH0002X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "IL",
            "license": "2002400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "50344",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Iroquois Memorial Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Iroquois Memorial Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Watseka, IL

Sources for this page

Verify at the official NPI Registry.