Prism Hospice, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

PRISM HOSPICE, LLC

Doing business as

Prism Hospice

Practice address

401 N Alma School Rd Ste 3
Chandler, AZ 85224-4369

Phone

(480) 687-9439

Fax

(480) 550-8558

NPI assigned

Aug 1, 2019

Last updated

Mar 15, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Edgar Delos Santos

Title

Manager

Phone

(951) 415-6942

Specialties & licenses 1

Addresses

Other names 1

• PRISM HOSPICE Doing business as

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023662665. Details of each certification follow.

• CCN 031708 Hospice · Active · Details

Hospice certification: CCN 031708

Legal name

PRISM HOSPICE LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Mar 11, 2020

Last certification

Mar 11, 2020

Ownership / control type

Proprietary - Partnership

Organization structure

LLCProprietary

Incorporated

Jul 29, 2019 in AZ

Enrollment address

401 N Alma School Rd
Ste 3
Chandler, AZ 85224-4369

Listed as

Prism HospiceCCN 031708 · All quality measures

Ownership

For-Profit

Certified

Mar 11, 2020

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 3

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

Owners & managing parties with NPI records 1

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

• Nathan Rex Duffin, D.O.

  • Internal Medicine Physician
  • Mesa, AZ
  • NPI 1497016190

  Corporate Director

  CMS ownership

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Eddie Belleza Tabarangao, ACNPC-AG

  • Acute Care Nurse Practitioner
  • Gilbert, AZ
  • NPI 1285030312
  NPD (past)

Affiliated clinicians 1

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

• Nathan Rex Duffin, D.O.

  • Internal Medicine Physician
  • Mesa, AZ
  • NPI 1497016190

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1564617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710460800000",
    "number": "1023662665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 N ALMA SCHOOL RD STE 3",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852244369",
            "telephone_number": "480-687-9439",
            "fax_number": "480-550-8558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 N ALMA SCHOOL RD STE 3",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852244369",
            "telephone_number": "480-687-9439",
            "fax_number": "480-550-8558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISM HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-01",
        "last_updated": "2024-03-15",
        "certification_date": "2024-03-15",
        "status": "A",
        "authorized_official_last_name": "DELOS SANTOS",
        "authorized_official_first_name": "EDGAR",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "951-415-6942"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PRISM HOSPICE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PRISM HOSPICE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.