Pediatric Services of America, LLC
Organization Active NPI Nursing Care Agency · Tinley Park, IL
NPI 1891740601 · NPPES record last updated Jan 27, 2025
Key facts
- NPI
- 1891740601
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nursing Care Agency 251J00000X
- License
- 1008101 (IL)
- Legal business name
- PEDIATRIC SERVICES OF AMERICA, LLC
- Practice address
- 18440 Thompson CT
Suite 108
Tinley Park, IL 60477-5426 - Phone
- (707) 429-5551
- Fax
- (708) 444-1278
- NPI assigned
- May 23, 2006
- Organization subpart
- No
Authorized official
- Name
- Matthew Buckhalter
- Title
- Cfo
- Phone
- (470) 464-8000
Owned or controlled facilities with NPI records 7
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 19
Corporate family (same tax ID) 3
Facilities with the same owner 122
Practitioners 1
Medicare Care Compare: Home health agency
- Listed as
- Aveanna Healthcare
- Ownership
- Proprietary
- Certified
- Feb 10, 1995
- Medicare certification status
- Active
- Services
- Nursing, Home health aide, Physical therapy, Speech pathology
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Home health agency certification: CCN 147600
- Legal name
- PEDIATRIC SERVICES OF AMERICA, LLC
- Doing business as
- AVEANNA HEALTHCARE
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Feb 10, 1995
- Last certification
- May 21, 2009
- Ownership / control type
- Proprietary
- Organization structure
- LLC · Proprietary
- Incorporated
- Dec 28, 2020 in GA
- Enrollment address
- 18440 Thompson CT
Ste 108
Tinley Park, IL 60477-5427
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| J.H. Whitney VII LP |
5% Or Greater Indirect Ownership Interest | Mar 16, 2017 | 6.18% |
| Kathleen Flynn |
W-2 Managing Employee |
May 4, 2012 | |
| Psa Healthcare Investment Holding LLC |
5% Or Greater Indirect Ownership Interest | Mar 16, 2017 | 7.14% |
| Aveanna Healthcare LLC |
5% Or Greater Indirect Ownership Interest | Mar 16, 2017 | 100% |
| Aveanna Healthcare Intermediate Holdings LLC |
5% Or Greater Indirect Ownership Interest | Mar 16, 2017 | 100% |
| Pediatric Services Holding LLC |
5% Or Greater Indirect Ownership Interest | Aug 31, 2007 | 100% |
| Aveanna Healthcare Holdings Inc |
5% Or Greater Indirect Ownership Interest | Mar 16, 2017 | 100% |
| Nut Tree Master Fund LP |
5% Or Greater Indirect Ownership Interest | Dec 31, 2023 | 5.69% |
| Matthew Buckhalter |
Corporate Officer |
Jul 7, 2023 | |
| Corporate Director |
Jul 7, 2023 | ||
| Hamilton Lane Co-Investment Fund III Holdings - 2 LP |
5% Or Greater Indirect Ownership Interest | Mar 16, 2017 | 6.68% |
| Deborah Stewart |
Corporate Director |
Jul 7, 2023 | |
| Bain Capital Fund XI LP |
5% Or Greater Indirect Ownership Interest | Mar 16, 2017 | 31.87% |
| Psa Healthcare Intermediate Holding LLC |
5% Or Greater Indirect Ownership Interest | Mar 19, 2015 | 100% |
| Jerrold Perchik |
Corporate Officer |
Apr 29, 2024 | |
| Pediatric Services of America LLC |
5% Or Greater Direct Ownership Interest | Aug 31, 2007 | 100% |
| Bcpe Eagle Investor, L.P. |
5% Or Greater Indirect Ownership Interest | Apr 29, 2021 | 37.52% |
| Jeffrey Shaner |
Corporate Officer |
Dec 1, 2015 | |
| Corporate Director |
Jan 1, 2023 |
All facility ownership & control disclosures 7
| Facility | Type | Role | Since |
|---|---|---|---|
| Aveanna Healthcare |
Home health agency | 5% Or Greater Indirect Ownership Interest (100%) | Sep 17, 2016 |
| Thrive Skilled Pediatric Care |
Home health agency | 5% Or Greater Indirect Ownership Interest (100%) | Jun 2, 2025 |
| Aveanna Healthcare |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2016 |
| Aveanna Healthcare |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Sep 26, 2020 |
| Aveanna Healthcare |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2016 |
| Aveanna Healthcare |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Sep 26, 2020 |
| Aveanna Healthcare |
Home health agency | 5% Or Greater Direct Ownership Interest (100%) | Feb 1, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080827000523 | IL | Part a Provider - Home Health Agency | 5991614760 |
1 other NPI on this enrollment Practice locations: Schaumburg, IL; Tinley Park, IL |
National Provider Directory
- Tax ID family
- Sleep Disorder Serv of
Locations
1000 Bridgeport Ave
Ste 309
Shelton, CT 06484
Phone (203) 381-1530
3105 Citrus Tower Blvd
Ste A
Clermont, FL 34711
Phone (352) 241-8016
42 Barkley Cir
Ste 3
Fort Myers, FL 33907
Phone (239) 939-3159
8659 Baypine Rd
Ste 100
Jacksonville, FL 32256
Phone (904) 730-2200
101 W Main St
Ste 121
Lakeland, FL 33815
Phone (863) 583-4953
23 Chatham Ctr S
#B
Savannah, GA 31405
Phone (912) 961-1017
920 Davis Rd
Ste 208
Elgin, IL 60123
Phone (847) 426-2551
9270 Siegen Ln
Bldg 903
Baton Rouge, LA 70810
3525 N Causeway Blvd
Ste 800
Metairie, LA 70002
Phone (504) 830-4512
4530 Park Rd
Ste 105
Charlotte, NC 28209
Phone (704) 335-9797
220A N McPherson Church Rd
Fayetteville, NC 28303
1025 W H Smith Blvd
Ste 100
Greenville, NC 27834
Phone (252) 756-7233
1400 N Providence Rd
Ste 300
Media, PA 19063
Phone (215) 887-4009
114 Commons Blvd
#C
Piedmont, SC 29673
Phone (864) 295-8655
5313 N McColl Rd
McAllen, TX 78504
Phone (956) 972-1920
6330 N Center Dr
Ste 142
Norfolk, VA 23502
Phone (757) 461-6310
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | |||
| Nursing Care Agency | 251J00000X | 1008101 | IL | Yes |
Addresses
Primary practice location
18440 Thompson CT
Suite 108
Tinley Park, IL 60477-5426
Mailing address
400 Interstate North Pkwy SE Ste 1600
Atlanta, GA 30339-5047
Phone (470) 464-8000
Other names
- Aveanna Healthcare
Other providers in Tinley Park, IL
- Palak Patel
- Pinky Patel
- Shilpaben Patel
- Angela Patrick
- Pediatric Services of America, LLC
- Mae O Pedroso Provo
- Lynda Pekala
- Kevin Pelczarski
- Alicia Dawn Penny
- Gary R Peplinski
All providers in Tinley Park, IL · Nursing Care Agency in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.