Pacific Hospice and Palliative Care, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

PACIFIC HOSPICE AND PALLIATIVE CARE, LLC

Practice address

4400 S Piedras Dr Ste 221
San Antonio, TX 78228-1222

Phone

(210) 275-2133

NPI assigned

May 17, 2022

Last updated

Jun 10, 2022By 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

Ivan Vargas

Title

Shareholder

Phone

(210) 275-2133

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053058495. Details of each certification follow.

• CCN A91539 Hospice · Active · Details

Hospice certification: CCN A91539

Legal name

PACIFIC HOSPICE AND PALLIATIVE CARE, LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Nov 23, 2022

Last certification

Nov 16, 2022

Ownership / control type

Other

Organization structure

LLCProprietary

Incorporated

May 5, 2022 in TX

Enrollment address

4400 S Piedras Dr
Ste 221
San Antonio, TX 78228-1222

Listed as

Pacific Hospice and Palliative Care, LLCCCN A91539 · All quality measures

Certified

Nov 23, 2022

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.

Affiliated clinicians 1

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

• Nageswarrao Pothula, MD

  • Emergency Medicine Physician
  • Flint, MI
  • NPI 1023246774

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1652745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654819200000",
    "number": "1053058495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 S PIEDRAS DR STE 221",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782281222",
            "telephone_number": "210-275-2133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 S PIEDRAS DR STE 221",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782281222",
            "telephone_number": "210-275-2133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFIC HOSPICE AND PALLIATIVE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-17",
        "last_updated": "2022-06-10",
        "certification_date": "2022-06-10",
        "status": "A",
        "authorized_official_last_name": "VARGAS",
        "authorized_official_first_name": "IVAN",
        "authorized_official_title_or_position": "SHAREHOLDER",
        "authorized_official_telephone_number": "210-275-2133"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Monica R. Pacheco, M.D.
• Ramon C Pacheco, LCDC
• Savannah Pacheco, LVN
• Viju Pachikara
• Brooke Pachon
• Pacifica New F Estates LLC (Newforest Estates)
• Emily Pack, IOM
• Marshall Brandon Packard, MD
• Pacsouth Distribution Delaware LLC (IOD Rx)
• Pact-Pediatric Associates at Clock Tower, LLC

• Community Based Hospice Care Agency in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Community Based Hospice Care Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2022; 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.