Hospice of the Midwest, LLC
Organization Active NPI Community Based Hospice Care Agency · Johnston, IA
NPI 1023401254 · NPPES record last updated Sep 8, 2022
Key facts
- NPI
- 1023401254
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- HOSPICE OF THE MIDWEST, LLC
- Practice address
- 9249 Northpark Dr
Johnston, IA 50131-2933 - Phone
- (515) 218-2143
- Fax
- (515) 218-2327
- NPI assigned
- Mar 12, 2015
- Organization subpart
- No
Authorized official
- Name
- Kevin McDaniel
- Title
- Secretary
- Phone
- (256) 810-1079
Other NPIs with the same Medicare PAC ID 1
Subparts reporting this organization as parent 2
Corporate family (same tax ID) 1
Member of 1
Facilities with the same owner 151
Affiliated clinicians 25
-
David R Ahrens, MD
-
Eric M Ash, MD
-
Seann M Atkinson, DO
-
Steven R Bascom, MD
-
Robert D Conner, DO
-
Thomas W. Fagg, D.O.
-
Dale Miller Grunewald, D.O.
-
David K Jones, MD
-
Timothy Piearson, D.O.
-
Carly M. Quam, DO
-
Lazaro Rabang, MD
-
Steve D Sohn, MD
-
Stephanie Vampola-Runyan, D.O.
-
Anuj Wadhwa, M.D.
-
Angela B Weppler, M.D.
Medicare Care Compare: Hospice
- Listed as
- Hospice of the Midwest, LLC
- Ownership
- For-Profit
- Certified
- Jan 21, 2016
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 16D2096937 | Hospice of the Midwest, LLC | Certificate of waiver | Jun 3, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Hospice certification: CCN 161609
- Legal name
- HOSPICE OF THE MIDWEST LLC
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Jan 21, 2016
- Last certification
- Sep 22, 2021
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- LLC · Proprietary
- Incorporated
- Jan 29, 2015 in DE
- Enrollment address
- 9249 Northpark Dr
Johnston, IA 50131-2933
All disclosed owners & managing parties 20
| Name | Role | Since | Share |
|---|---|---|---|
| Kevin McDaniel |
Corporate Officer |
Dec 3, 2021 | |
| Corporate Director |
Dec 3, 2021 | ||
| Jennifer Phipps |
Corporate Officer |
Jul 22, 2022 | |
| Walgreen Co |
5% Or Greater Indirect Ownership Interest | Apr 16, 2021 | 29% |
| Silverton Abode Holding Corporation |
5% Or Greater Indirect Ownership Interest | Aug 28, 2019 | 100% |
| Margaret Sherry Pemberton |
Corporate Officer |
Dec 3, 2021 | |
| Corporate Director |
Dec 3, 2021 | ||
| Brightspring Health Holdings Corp |
5% Or Greater Indirect Ownership Interest | Apr 16, 2021 | 100% |
| Silverton Intermediate Holdings, Inc. |
5% Or Greater Indirect Ownership Interest | Aug 28, 2019 | 100% |
| Phoenix Guarantor Inc. |
5% Or Greater Indirect Ownership Interest | Apr 16, 2021 | 100% |
| Res-Care Inc |
5% Or Greater Indirect Ownership Interest | Apr 16, 2021 | 100% |
| Silverton Holdings, Inc. |
5% Or Greater Indirect Ownership Interest | Aug 28, 2019 | 100% |
| Phoenix Intermediate Holdings Inc. |
5% Or Greater Indirect Ownership Interest | Apr 16, 2021 | 100% |
| Abode Healthcare, Inc. |
5% Or Greater Indirect Ownership Interest | Jan 29, 2015 | 100% |
| Walgreens Holding Company |
5% Or Greater Indirect Ownership Interest | Apr 16, 2021 | 29% |
| Brightspring Health Services Inc |
5% Or Greater Indirect Ownership Interest | Apr 16, 2021 | 100% |
| KKR Phoenix Aggregator L.P. |
5% Or Greater Indirect Ownership Interest | Apr 16, 2021 | 68% |
| Lynnea Anderson |
W-2 Managing Employee |
Aug 28, 2019 | |
| KKR Americas Fund XII LP |
5% Or Greater Indirect Ownership Interest | Apr 16, 2021 | 60% |
| Michael a McMaude |
Corporate Officer |
Jan 29, 2015 | |
| Corporate Director |
Jan 29, 2015 | ||
| Silverton Abode, LLC |
5% Or Greater Indirect Ownership Interest | Aug 28, 2019 | 100% |
| Abode Iowa LLC |
5% Or Greater Direct Ownership Interest | Jan 29, 2015 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150702000077 | IA | Part a Provider - Hospice | 7113239211 | Practice locations: Guthrie Center, IA; Johnston, IA; Marshalltown, IA |
National Provider Directory
- Tax ID family
- Hospice of the Midwest LLC
Locations
9203 Northpark Dr
Johnston, IA 50131
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
9249 Northpark Dr
Johnston, IA 50131-2933
Mailing address
9249 Northpark Dr
Johnston, IA 50131-2933
Phone (515) 218-2143
Other providers in Johnston, IA
- Homesafe Iowa LLC
- Erin Rae Honke
- Hope Residential Healthcare LLC
- Hopestone Therapy LLC
- Angela Hopkins
- Kristin Brooke Housholder
- Stephanie Jane Houston
- Danielle Hubby
- Sydney Charlize Hughes
- Leah Hughett
All providers in Johnston, IA · Community Based Hospice Care Agency in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.