NPIMap

Organization Active NPI

Affinis Hospice, LLC

Doing business as Affinis Hospice

  • Community Based Hospice Care Agency
  • Newnan, GA
National Provider Identifier
1013288299
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
AFFINIS HOSPICE, LLC
Doing business as
Affinis Hospice
Practice address
21 Highland Dr
Newnan, GA 30265-1738
Phone
(404) 832-4232
Fax
(404) 832-4233
NPI assigned
Jan 20, 2012
Last updated
Nov 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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

Authorized official

Name
Mrs. Sarah A Thompson, RN, CHPN
Title
Director of Operations
Phone
(770) 475-6540

Specialties & licenses 1

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

Addresses

Primary practice location

21 Highland Dr
Newnan, GA 30265-1738

Mailing address

806 Maple Dr
Vidalia, GA 30474-7208
Phone (912) 538-0465

Other names 1

  • Affinis Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120329000487 GA Part A Provider - Hospice 1759579253 Practice locations: Newnan, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013288299. Details of each certification follow.

Hospice certification: CCN 111728

Legal name
AFFINIS HOSPICE, LLC
Doing business as
AFFINIS HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Sep 27, 2012
Last certification
Sep 9, 2021
Ownership / control type
Non-Profit - Private
Organization structure
LLCProprietary
Incorporated
Dec 9, 2009 in GA
Enrollment address
21 Highland Drive
Newnan, GA 30265-1738

Other NPIs with the same Medicare PAC ID 10

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Affinis HospiceCCN 111728 · All quality measures
Ownership
For-Profit
Certified
Sep 27, 2012
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2053487Affinis Hospice, LLC21 Highland Drive, Newnan, GA 30265Certificate of waiverJan 31, 2027

National Provider Directory

National Provider Directory
Tax ID family
Affinis Hospice11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

21 Highland Dr
Newnan, GA 30265
Phone (404) 832-4232

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Home and Community Services Inc Organization, Gray, GA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2021 100%
Wyatt K Blake Individual Operational/Managerial ControlMedical Director Jan 1, 2026 100%
Amy Tomlin Individual Corporate DirectorAdministrator May 13, 2019 100%
Sarah a Thompson Individual Corporate Director Jan 1, 2012
W-2 Managing Employee Jan 1, 2012
Operational/Managerial Control Jan 1, 2012

Owners & managing parties with NPI records 1

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

Facilities with the same owner 11

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

Practitioners & affiliated clinicians

Affiliated clinicians 3

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

NPI Registry JSON

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

{
    "created_epoch": "1327017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698969600000",
    "number": "1013288299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "806 MAPLE DR",
            "city": "VIDALIA",
            "state": "GA",
            "postal_code": "304747208",
            "telephone_number": "912-538-0465",
            "fax_number": "912-538-0467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 HIGHLAND DR",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302651738",
            "telephone_number": "404-832-4232",
            "fax_number": "404-832-4233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AFFINIS HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-20",
        "last_updated": "2023-11-03",
        "certification_date": "2023-11-03",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "SARAH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "770-475-6540",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN, CHPN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Affinis Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Affinis Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newnan, GA

Sources for this page

Verify at the official NPI Registry.