NPIMap

Organization Active NPI

Palos Community Hospital

  • Community Based Hospice Care Agency
  • Lemont, IL
National Provider Identifier
1962477919
Registry record updated Jul 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
1652451 Issued in IL
Legal business name
PALOS COMMUNITY HOSPITAL
Practice address
15295 East 127TH Street
Palos Community Hospital Hospice
Lemont, IL 60439-7405
Phone
(630) 257-1111
Fax
(630) 257-1461
NPI assigned
Feb 22, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2024

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

Authorized official

Name
Jeff Good
Title
President
Phone
(708) 923-5000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 1652451 IL Primary

Addresses

Primary practice location

15295 East 127TH Street
Palos Community Hospital Hospice
Lemont, IL 60439-7405

Mailing address

15295 East 127TH Street
Palos Community Hospital Hospice
Lemont, IL 60439-7405
Phone (630) 257-1111

Other names 1

  • Palos Community Hospital Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120904000264 IL Part A Provider - Hospice 6305753153 Practice locations: Lemont, IL

Hospice certification: CCN 141591

Legal name
PALOS COMMUNITY HOSPITAL
Doing business as
PALOS COMMUNITY HOSPITAL HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 6, 1997
Last certification
Apr 13, 2019
Ownership / control type
Non-Profit - Private
Organization structure
CorporationNon-profit
Incorporated
May 2, 1938 in IL
Enrollment address
15295 E 127TH St
Lemont, IL 60439-7405

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Palos Community Hospital HospiceCCN 141591
Ownership
Non-Profit
Certified
Jun 6, 1997
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Palos Community Hospita6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

15295 E 127th St
Lemont, IL 60439
Phone (630) 257-1111

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 Director 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 Director Sep 1, 2025
Michael J Mullen Individual Corporate OfficerRevenue 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 DirectorCeo Jan 1, 2021
Kermit R Crawford Individual Corporate DirectorBoard Member Sep 1, 2022
Michael V Vivoda Individual Corporate OfficerPresident Sep 1, 2023
Corporate DirectorPresident 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 5% Or Greater Direct Ownership Interest Jan 1, 2021 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

Affiliated clinicians 57

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

View all 57

NPI Registry JSON

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719878400000",
    "number": "1962477919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15295 EAST 127TH STREET",
            "address_2": "PALOS COMMUNITY HOSPITAL HOSPICE",
            "city": "LEMONT",
            "state": "IL",
            "postal_code": "604397405",
            "telephone_number": "630-257-1111",
            "fax_number": "630-257-1461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15295 EAST 127TH STREET",
            "address_2": "PALOS COMMUNITY HOSPITAL HOSPICE",
            "city": "LEMONT",
            "state": "IL",
            "postal_code": "604397405",
            "telephone_number": "630-257-1111",
            "fax_number": "630-257-1461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALOS COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-22",
        "last_updated": "2024-07-02",
        "certification_date": "2024-07-02",
        "status": "A",
        "authorized_official_last_name": "GOOD",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-923-5000"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "IL",
            "license": "1652451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Palos Community Hospital Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lemont, IL

Sources for this page

Verify at the official NPI Registry.