Mga Home Healthcare Tennessee, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

MGA HOME HEALTHCARE TENNESSEE, LLC

Doing business as

MGA Homecare

Practice address

3310 West End Ave
Ste 500
Nashville, TN 37203-1087

Phone

(901) 335-9832

NPI assigned

Nov 29, 2023

Last updated

Nov 29, 2023By 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

Alexandra Lee Koloskus, JD

Title

Chief Compliance Officer

Phone

(720) 276-7706

Specialties & licenses 1

Addresses

Other names 1

• MGA Homecare Doing business as

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053187203. Details of each certification follow.

• CCN 447825 Home health agency · Active · Details

Home health agency certification: CCN 447825

Legal name

MGA HOME HEALTHCARE TENNESSEE, LLC

Doing business as

MGA HOMECARE

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Apr 17, 2023

Last certification

Apr 5, 2023

Organization structure

LLCProprietary

Incorporated

Feb 4, 2022 in TN

Enrollment address

1669 Kirby Pkwy
Ste 100
Memphis, TN 38120-4397

Other NPIs on the same Medicare enrollment 1

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

• Mga Home Healthcare Tennessee, LLC

  • Home Health Agency
  • Memphis, TN
  • NPI 1851039978

  O20230203001614

  Same enrollment

Listed as

Mga HomecareCCN 447825 · All quality measures

Ownership

-

Certified

Apr 17, 2023

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

Tax ID family

Mga Home Healthcare Tennessee2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mga Home Healthcare Tennessee, LLC

  • Home Health Agency
  • Memphis, TN
  • NPI 1851039978
  NPD tax ID

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Yale University

  • Durable Medical Equipment & Medical Supplies
  • Wallingford, CT
  • NPI 1053079335

  Member Of

  NPD member

Locations

All disclosed owners & managing parties 20

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 12

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

• Yale University

  • Durable Medical Equipment & Medical Supplies
  • Wallingford, CT
  • NPI 1053079335

  5% Or Greater Indirect Ownership Interest

  CMS ownership
• Yale University

  dba Yale Health Center

  • Health Service Clinic/Center
  • New Haven, CT
  • NPI 1093862740

  5% Or Greater Indirect Ownership Interest

  CMS ownership
• Yale University

  • Durable Medical Equipment & Medical Supplies
  • North Haven, CT
  • NPI 1104530666

  5% Or Greater Indirect Ownership Interest

  CMS ownership
• Yale University

  • Durable Medical Equipment & Medical Supplies
  • Milford, CT
  • NPI 1144985482

  5% Or Greater Indirect Ownership Interest

  CMS ownership
• Yale University

  dba Yale Medicine

  • Anesthesiology Physician
  • New Haven, CT
  • NPI 1205822236

  5% Or Greater Indirect Ownership Interest

  CMS ownership
• Yale University

  dba Yale Pathology Labs

  • Clinical Medical Laboratory
  • New Haven, CT
  • NPI 1306875877

  5% Or Greater Indirect Ownership Interest

  CMS ownership
• Yale University

  • Durable Medical Equipment & Medical Supplies
  • Fairfield, CT
  • NPI 1548066962

  5% Or Greater Indirect Ownership Interest

  CMS ownership
• Yale University

  • Durable Medical Equipment & Medical Supplies
  • Milford, CT
  • NPI 1740099407

  5% Or Greater Indirect Ownership Interest

  CMS ownership
• Yale University

  • Durable Medical Equipment & Medical Supplies
  • Stamford, CT
  • NPI 1831854173

  5% Or Greater Indirect Ownership Interest

  CMS ownership
• Yale University

  dba Yale Medicine

  • Durable Medical Equipment & Medical Supplies
  • New Haven, CT
  • NPI 1912040205

  5% Or Greater Indirect Ownership Interest

  CMS ownership
• Yale University

  dba Yale Dermatopathology Lab

  • Clinical Medical Laboratory
  • New Haven, CT
  • NPI 1922042258

  5% Or Greater Indirect Ownership Interest

  CMS ownership
• Yale University

  • Durable Medical Equipment & Medical Supplies
  • Guilford, CT
  • NPI 1962167395

  5% Or Greater Indirect Ownership Interest

  CMS ownership

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

{
    "created_epoch": "1701216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701216000000",
    "number": "1053187203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3310 WEST END AVE",
            "address_2": "STE 500",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372031087",
            "telephone_number": "901-335-9832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3310 WEST END AVE",
            "address_2": "STE 500",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372031087",
            "telephone_number": "901-335-9832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MGA HOME HEALTHCARE TENNESSEE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-29",
        "last_updated": "2023-11-29",
        "certification_date": "2023-11-29",
        "status": "A",
        "authorized_official_last_name": "KOLOSKUS",
        "authorized_official_first_name": "ALEXANDRA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "720-276-7706",
        "authorized_official_credential": "JD"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MGA Homecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kori Meyers, LPC-MHSP
• Marilyn Gautreau Meyers
• Stephanie S Meyers, FNP
• Jacqueline Charlene Meystedt, MD
• Haile M Mezghebe, MD
• MH DMD of Tennessee, PLLC (Smile Store)
• MHC Uh Inc
• MHP Management Services, LLC (Pathpoint Health)
• Mi Plaza Dental
• Humayun Afzal Mian, M.D.

• Home Health Agency in Nashville, TN
• Providers in Nashville, TN by specialty
• Home Health Agency in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2023; 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.