NPIMap

Organization Active NPI

Pediatric Services of America, LLC

  • Home Health Agency
  • Media, PA
National Provider Identifier
1023045218
Registry record updated Jan 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
758305 Issued in PA
Legal business name
PEDIATRIC SERVICES OF AMERICA, LLC
Practice address
1400 N Providence Rd Ste 300 South
Media, PA 19063-2050
Phone
(215) 887-4009
Fax
(215) 887-4246
NPI assigned
Jun 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2025

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

Authorized official

Name
Matthew Buckhalter
Title
Cfo
Phone
(470) 464-8000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 758305 PA Primary

Addresses

Primary practice location

1400 N Providence Rd Ste 300 South
Media, PA 19063-2050

Mailing address

400 Interstate North Pkwy SE Ste 1600
Atlanta, GA 30339-5047
Phone (470) 464-8000

Other identifiers 1

IdentifierTypeStateIssuer
100007962 0017MedicaidPA

Other names 1

  • Aveanna Healthcare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050215000951 PA Part A Provider - Home Health Agency 5991614760 2 other NPIs on this enrollment
Practice locations: Media, PA; Reading, PA

Home health agency certification: CCN 397583

Legal name
PEDIATRIC SERVICES OF AMERICA, LLC
Doing business as
AVEANNA HEALTHCARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Mar 21, 1994
Last certification
Dec 8, 2017
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Dec 28, 2020 in GA
Enrollment address
1400 N Providence Rd
Ste 300
Media, PA 19063-2050

Other NPIs with the same Medicare PAC ID 19

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

View all 19

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Home health agency

Medicare Care Compare
Listed as
Aveanna HealthcareCCN 397583
Ownership
Proprietary
Certified
Mar 21, 1994
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide

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
39D0884701Pediatric Services of America, LLC1400 N Providence Road, Ste 300 South, Media, PA 19063Certificate of waiverApr 6, 2028

National Provider Directory

National Provider Directory
Tax ID family
Sleep Disorder Serv of76 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 6

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

1400 N Providence Rd
Ste 300S
Media, PA 19063
Phone (215) 887-4009

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
J.H. Whitney VII LP Organization, New Canaan, CT For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 16, 2017 16.36%
Psa Healthcare Investment Holding LLC Organization, New Canaan, CT LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 16, 2017 8.17%
Aveanna Healthcare LLC Organization, Atlanta, GA Created for acquisition, LLC, For-profit, Chain home office, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 16, 2017 100%
Aveanna Healthcare Intermediate Holdings LLC Organization, Atlanta, GA Created for acquisition, LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 16, 2017 100%
Pediatric Services Holding LLC Organization, Atlanta, GA Created for acquisition, LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Aug 31, 2007 100%
Aveanna Healthcare Holdings Inc Organization, Atlanta, GA Created for acquisition, Corporation, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 16, 2017 100%
Nut Tree Master Fund LP Organization, New York, NY For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 31, 2023 6.43%
Matthew Buckhalter Individual Corporate OfficerCfo Jul 7, 2023
Corporate DirectorCfo Jul 7, 2023
Bcip Associates IV US L.P. Organization, Boston, MA For-profit, Private equity company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 16, 2017 5.43%
Hamilton Lane Co-Investment Fund III Holdings - 2 LP Organization, Bala Cynwyd, PA For-profit, Private equity company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 16, 2017 7.62%
Deborah Stewart Individual Corporate DirectorDirector Jul 7, 2023
Bain Capital Fund XI LP Organization, Boston, MA For-profit, Private equity company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 16, 2017 36.04%
Psa Healthcare Intermediate Holding LLC Organization, Atlanta, GA Created for acquisition, LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 19, 2015 100%
Melanie Serago Individual W-2 Managing EmployeeAd; Dec 16, 2024
Jerrold Perchik Individual Corporate OfficerSecretary Apr 29, 2024
Pediatric Services of America LLC Organization, Atlanta, GA Created for acquisition, LLC, Holding company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Aug 31, 2007 100%
Bcpe Eagle Investor, L.P. Organization, Boston, MA Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 29, 2021 42.42%
Jeffrey Shaner Individual Corporate OfficerCeo Dec 1, 2015
Corporate DirectorCeo Jan 1, 2023
Pea Washington Holdings, LP Organization, George Town For-profit, Private equity company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 29, 2021 5.54%

All facility ownership & control disclosures 7

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Aveanna HealthcareEnglewood, CO, CCN 067192 Home health agency 5% Or Greater Indirect Ownership Interest (100%) Sep 17, 2016
Thrive Skilled Pediatric CareScottsdale, AZ, CCN 037286 Home health agency 5% Or Greater Indirect Ownership Interest (100%) Jun 2, 2025
Aveanna HealthcareErie, PA, CCN 397310 Home health agency 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2016
Aveanna HealthcareLoveland, CO, CCN 067477 Home health agency 5% Or Greater Direct Ownership Interest (100%) Sep 26, 2020
Aveanna HealthcareWexford, PA, CCN 397278 Home health agency 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2016
Aveanna HealthcareWestminster, CO, CCN 067496 Home health agency 5% Or Greater Direct Ownership Interest (100%) Sep 26, 2020
Aveanna HealthcareDu Bois, PA, CCN 398190 Home health agency 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2016

Owned or controlled facilities with NPI records 7

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 122

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

  • Andventure, LLC
    • Home Health Agency
    • Chambersburg, PA
    • NPI 1013150275

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Andventure, LLC
    • Home Health Agency
    • Lancaster, PA
    • NPI 1093788002

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Andventure, LLC
    • Home Health Agency
    • State College, PA
    • NPI 1760621122

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Angel'S Touch Home Care, LLC
    • Home Health Agency
    • West Pittston, PA
    • NPI 1376762237

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Care Unlimited Inc
    • Home Health Agency
    • Du Bois, PA
    • NPI 1811279540

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Care Unlimited Inc.
    • Home Health Agency
    • Wexford, PA
    • NPI 1407809114

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Care Unlimited Inc.
    • Home Health Agency
    • Erie, PA
    • NPI 1912101726

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Epic Health Services (PA), LLC
    • Home Health Agency
    • East Norriton, PA
    • NPI 1033570445

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Epic Health Services (PA), LLC
    • Home Health Agency
    • Bala Cynwyd, PA
    • NPI 1326058223

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Loving Care Agency, Inc.
    • Home Health Agency
    • East Stroudsburg, PA
    • NPI 1245368927

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Loving Care Agency, Inc.
    • Home Health Agency
    • Allentown, PA
    • NPI 1558490169

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Loving Care Agency, Inc.
    • Home Health Agency
    • Trevose, PA
    • NPI 1912035585

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
View all 122

NPI Registry JSON

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737936000000",
    "number": "1023045218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 INTERSTATE NORTH PKWY SE STE 1600",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303395047",
            "telephone_number": "470-464-8000",
            "fax_number": "770-248-8192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 N PROVIDENCE RD STE 300 SOUTH",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "190632050",
            "telephone_number": "215-887-4009",
            "fax_number": "215-887-4246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC SERVICES OF AMERICA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A",
        "authorized_official_last_name": "BUCKHALTER",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "470-464-8000"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "PA",
            "license": "758305",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100007962 0017",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aveanna Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Media, PA

Sources for this page

Verify at the official NPI Registry.