Custom Hospice, LLC
A Medicare group practice based in Troy, MI: 2 NPIs enrolled under one PECOS associate control ID (PAC ID 8820242993), with 3 clinicians.
Medicare enrollment
Medicare enrollment files- PAC ID
- 8820242993
- Provider type
- Part A Provider - Hospice, Part B Supplier - Clinic/Group Practice
- Enrolled in
- MI
- Enrollments
- 2
- Group size
- 3 clinicians
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Practice locations
- 2
Enrollment records 2
| Enrollment ID | State | Provider type | NPI |
|---|---|---|---|
| O20130128000121 | MI | Part A Provider - Hospice | 1558613281 |
| O20191211003133 | MI | Part B Supplier - Clinic/Group Practice | 1306480538 |
NPIs in this group 2
NPPES NPI RegistryThese NPI records belong to the same enrolled organization. Each has its own page.
-
Custom Hospice, LLC
dba Custom Palliative Care
- Adult Health Nurse Practitioner
- Troy, MI
- NPI 1306480538
-
Custom Hospice, LLC
- Community Based Hospice Care Agency
- Troy, MI
- NPI 1558613281
Practice locations
- Troy, MI2
Clinicians 3
Clinicians who reassign their Medicare benefits to this group (3) or whom Care Compare lists as members (3).
-
Samantha Michelle Kaczmarek, FNP-BC
- Family Nurse Practitioner
- Troy, MI
- NPI 1154968667
-
Jenna Oliver, FNP-BC
- Family Nurse Practitioner
- Troy, MI
- NPI 1871300590
-
Sophia Jane Poley, DNP, FNP-BC
- Nurse Practitioner
- Troy, MI
- NPI 1154167575
Sources for this page
- Medicare Fee-For-Service Public Provider Enrollment: the enrollments, PAC ID, practice locations and benefit reassignments.
- Care Compare Doctors and Clinicians: group membership, group size and the name CMS shows patients.
- NPPES NPI Registry: the names and addresses of the NPIs above.