NPIMap

Organization Active NPI

Palos Community Hospital

  • General Acute Care Hospital
  • Palos Heights, IL
National Provider Identifier
1851386692
Registry record updated Apr 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
0003210 Issued in IL
Legal business name
PALOS COMMUNITY HOSPITAL
Practice address
12251 S 80TH Ave
Palos Heights, IL 60463-1256
Phone
(708) 361-4500
Fax
(708) 923-4000
NPI assigned
Sep 19, 2005
Last updated
Apr 16, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2026

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

Authorized official

Name
Mr. Michael V Vivoda
Title
President
Phone
(708) 923-5000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X NU
General Acute Care Hospital 282N00000X 0003210 IL Primary

Addresses

Primary practice location

12251 S 80TH Ave
Palos Heights, IL 60463-1256

Mailing address

12251 S 80TH Ave Ste 1630
Palos Heights, IL 60463-1290
Phone (708) 923-5173

Other identifiers 2

IdentifierTypeStateIssuer
52OtherILBLUE CROSS NUMBER
16020MedicaidIL

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.cms.gov/research-statistics-data-systems/electronic-submission-medicaldocumentation-esmd/cms-health-information-handler Other CMS HIH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080125000358 IL Part A Provider - Hospital 6305753153 1 other NPI on this enrollment
Practice locations: Orland Park, IL; Palos Heights, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851386692. Details of each certification follow.

Hospital certification: CCN 140062

Legal name
PALOS COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jun 30, 2011
Beds
436
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
May 2, 1938 in IL
Enrollment address
12251 S 80TH Ave
Palos Heights, IL 60463-1290
Main/Primary Hospital Location
Hospital subgroups
Acute care

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Palos Community HospitalCCN 140062 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 28

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

NameRoleSinceShare
Anthony K Kesman Individual Corporate DirectorBoard Member Sep 1, 2022
Jose Carlos Gonzalez-Mendez Individual Corporate DirectorBoard Member Sep 1, 2022
Bahram Ghaderi Individual Corporate DirectorBoard Member Sep 1, 2025
James Zallie Individual Corporate DirectorBoard Member Sep 1, 2022
Michael J Leonard Individual Corporate DirectorBoard Member Jan 1, 2021
Carol L Bernick Individual Corporate DirectorBoard Member Sep 1, 2022
Beatrice Correa Rivera Individual Corporate Director Jun 22, 2025
Ikechukwu I Chineme Individual Corporate DirectorBoard Member Sep 1, 2025
Michael J Mullen Individual Corporate OfficerRev Cycle Jan 1, 2022
Aaron S Epstein Individual Corporate DirectorBoard Member Sep 1, 2024
John J Guido Individual Corporate DirectorBoard Member Jan 1, 2024
Dean M Harrison Individual Corporate OfficerCeo Jan 1, 2021
Corporate DirectorBoard Member Jan 1, 2021
Kermit R Crawford Individual Corporate DirectorBoard Member Sep 1, 2022
Michael V Vivoda Individual Corporate OfficerPresident Sep 1, 2023
W-2 Managing EmployeePresident Sep 1, 2023
Howard B Chrisman Individual Corporate DirectorBoard Member Jan 1, 2023
Thomas a Carey Individual Corporate DirectorBoard Member Sep 1, 2022
William P Flesch Individual Corporate DirectorBoard Member Sep 1, 2022
Michele C Montpetit Individual Corporate DirectorBoard Member Sep 1, 2024
Charles Ruth Individual Corporate DirectorBoard Member Sep 1, 2022
Joseph R Crane Individual Corporate DirectorBoard Member Jan 1, 2021
Scott P Serota Individual Corporate DirectorBoard Member Jan 1, 2021
Forrest R Whittaker Individual Corporate DirectorBoard Member Sep 1, 2022
James Thorpe Individual Corporate DirectorBoard Member Sep 1, 2022
Northwestern Memorial Healthcare Organization, Chicago, IL Corporation, Non-profit Operational/Managerial Control Nov 6, 2020 100%
Kevin Poorten Individual Corporate DirectorBoard Member Sep 1, 2022
Scott L Gwilliam Individual Corporate DirectorBoard Member Sep 1, 2022
Stephen L Davis Individual Corporate DirectorBoard Member Sep 1, 2022
Deborah S Saran Individual Corporate DirectorBoard Member Sep 1, 2022

Owners & managing parties with NPI records 6

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

Facilities with the same owner 13

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

View all 13

Practitioners & affiliated clinicians

Practitioners 17

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.

View all 17

Affiliated clinicians 1,712

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

View all 1,712

NPI Registry JSON

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

{
    "created_epoch": "1127088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776297600000",
    "number": "1851386692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12251 S 80TH AVE STE 1630",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631290",
            "telephone_number": "708-923-5173",
            "fax_number": "708-923-5018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12251 S 80TH AVE",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631256",
            "telephone_number": "708-361-4500",
            "fax_number": "708-923-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALOS COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-19",
        "last_updated": "2026-04-16",
        "certification_date": "2026-04-16",
        "status": "A",
        "authorized_official_last_name": "VIVODA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-923-5000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "IL",
            "license": "0003210",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS NUMBER",
            "identifier": "52",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "16020",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.cms.gov/research-statistics-data-systems/electronic-submission-medicaldocumentation-esmd/cms-health-information-handler",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.13.34.110.1.998.01",
            "affiliationName": "CMS HIH",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "7500 Security Blvd",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212441849",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Palos Heights, IL

Sources for this page

Verify at the official NPI Registry.