Petersen Health Network, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1652779 Issued in IL

Legal business name

PETERSEN HEALTH NETWORK, LLC

Doing business as

Nokomis Rehabilitation & Health Care Center

Practice address

505 Stevens St
Nokomis, IL 62075-1442

Phone

(217) 563-7725

Fax

(217) 563-8518

NPI assigned

Oct 11, 2005

Last updated

Feb 2, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Mark B Petersen

Title

President

Phone

(309) 691-8113

Specialties & licenses 1

Addresses

Other names 1

• Nokomis Rehabilitation & Health Care Center Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952399255. Details of each certification follow.

• CCN 145478 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 145478

Legal name

PETERSEN HEALTH NETWORK, LLC

Doing business as

NOKOMIS REHABILITATION & HEALTH CARE CENTER

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Aug 25, 1983

Last certification

Nov 18, 2024

Beds

92

Ownership / control type

Corporation

Multi-facility organization

Petersen Healthcare

Most recent change of ownership

Nov 1, 2009

Organization structure

LLCProprietary

Incorporated

Jun 16, 2009 in IL

Enrollment address

505 Stevens St
Nokomis, IL 62075-1442

Nursing home name

NOKOMIS HC & SENIOR LIVING

All disclosed owners & managing parties 2

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

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

{
    "created_epoch": "1128988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485993600000",
    "number": "1952399255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 W TRAILCREEK DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616141862",
            "telephone_number": "309-691-8113",
            "fax_number": "309-691-8622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 STEVENS ST",
            "city": "NOKOMIS",
            "state": "IL",
            "postal_code": "620751442",
            "telephone_number": "217-563-7725",
            "fax_number": "217-563-8518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSEN HEALTH NETWORK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-11",
        "last_updated": "2017-02-02",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-691-8113",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IL",
            "license": "1652779",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Nokomis Rehabilitation & Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pana Community Hospital Association (Community Medical Clinic of Nokomis)
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• Pana Community Hosptial Association (Nokomis Medical Group)
• Petersen Health Care - Nokomis, LLC (Nokomis Rehabilitation & Health Care Center)
• Robert Gollon (Bob's Pharmacy)
• Springfield Clinic, LLP
• Nicole Tonette Stauder, P.T.

• Skilled Nursing Facility in Nokomis, IL
• Providers in Nokomis, IL by specialty
• Skilled Nursing Facility in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.