NPIMap

Organization Active NPI

Southern Pines Healthcare LLC

Doing business as Frontier Hospice

  • Community Based Hospice Care Agency
  • Benbrook, TX
National Provider Identifier
1033715248
Registry record updated Jul 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
SOUTHERN PINES HEALTHCARE LLC
Doing business as
Frontier Hospice
Practice address
6410 Southwest Blvd Ste 127
Benbrook, TX 76109-6918
Phone
(832) 553-2276
NPI assigned
Dec 11, 2020
Last updated
Jul 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2025

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

Authorized official

Name
Amber L Tueller
Title
Secretary
Phone
(208) 207-2726

Specialties & licenses 1

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

Addresses

Primary practice location

6410 Southwest Blvd Ste 127
Benbrook, TX 76109-6918

Mailing address

6410 Southwest Blvd Ste 127
Benbrook, TX 76109-6918
Phone (832) 553-2276

Other names 1

  • Frontier Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210219001045 TX Part A Provider - Hospice 2264847599 Practice locations: Benbrook, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1033715248. Details of each certification follow.

Hospice certification: CCN 741720

Legal name
SOUTHERN PINES HEALTHCARE LLC
Doing business as
FRONTIER HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Apr 8, 2018
Last certification
Apr 9, 2018
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Enrollment address
6410 Southwest Blvd
Ste 127
Benbrook, TX 76109-6918

Care Compare: Hospice

Medicare Care Compare
Listed as
Frontier HospiceCCN 741720 · All quality measures
Ownership
For-Profit
Certified
Apr 8, 2018
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
45D2132498Southern Pines Healthcare LLC D/B/a Frontier6410 Southwest Boulevard, Suite 127, Benbrook, TX 76109Certificate of waiverJun 19, 2027

National Provider Directory

National Provider Directory

Locations

363 N Sam Houston Pkwy E
Ste 545
Houston, TX 77060
Phone (832) 553-2276

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Cornerstone Healthcare Inc Organization, Eagle, ID Corporation, For-profit 5% Or Greater Direct Ownership Interest Jan 1, 2021 100%
Brent Mills Individual Corporate OfficerTreasurer Mar 26, 2026
Jonathan Travis Jones Individual W-2 Managing EmployeeAdmonistrator Designee Dec 14, 2024
Molly Dame Individual W-2 Managing EmployeeDirector of Clinical Services Aug 19, 2025
Charles S Childers Individual Contracted Managing EmployeeMD; Dec 3, 2025
W-2 Managing EmployeeMD; Dec 3, 2025
The Pennant Group Inc Organization, Eagle, ID Corporation, For-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2021 100%
Lisa Flores Individual W-2 Managing EmployeeDirector of Clinical Services Desig Nov 21, 2025
Shelton Johnson Individual Contracted Managing EmployeeAd;Executive Director Oct 27, 2025
W-2 Managing EmployeeAd;Executive Director Oct 27, 2025
John J Gochnour Individual Corporate OfficerPresident Mar 26, 2026
Amber Tueller Individual Corporate OfficerSecretary Apr 10, 2024
Elliot McMillan Individual Corporate OfficerVice President Apr 10, 2024

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 141

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

View all 141

Practitioners & affiliated clinicians

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.

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": "1607644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752624000000",
    "number": "1033715248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6410 SOUTHWEST BLVD STE 127",
            "city": "BENBROOK",
            "state": "TX",
            "postal_code": "761096918",
            "telephone_number": "832-553-2276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6410 SOUTHWEST BLVD STE 127",
            "city": "BENBROOK",
            "state": "TX",
            "postal_code": "761096918",
            "telephone_number": "832-553-2276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN PINES HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-11",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "status": "A",
        "authorized_official_last_name": "TUELLER",
        "authorized_official_first_name": "AMBER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "208-207-2726"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Frontier Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Benbrook, TX

Sources for this page

Verify at the official NPI Registry.