Kaiser Foundation Hospitals

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

070000571 Issued in CA

Legal business name

KAISER FOUNDATION HOSPITALS

Doing business as

Kaiser Foundation Hospital Hospice - Martinez

Practice address

200 Muir Rd
Martinez, CA 94553-4614

Phone

(925) 229-7801

NPI assigned

Nov 27, 2006

Last updated

Apr 20, 2021By 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

Ms. Colleen McKeown

Title

Senior Vice President, Area Manager

Phone

(925) 295-5888

Specialties & licenses 1

Addresses

Other names 1

• Kaiser Foundation Hospital Hospice - Martinez Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053487793. Details of each certification follow.

• CCN 051552 Hospice · Active · Details

Hospice certification: CCN 051552

Legal name

KAISER FOUNDATION HOSPITALS

Doing business as

KAISER PERMANENTE HOSPITAL HOSPICE - MARTINEZ

Certification status

Active

Provider type (POS)

Hospice

Participating since

Jun 14, 1989

Last certification

Mar 7, 2018

Ownership / control type

Non-Profit - Other

Organization structure

CorporationNon-profit

Incorporated

Feb 19, 1948 in CA

Enrollment address

200 Muir Rd
Martinez, CA 94553-4614

Listed as

Kaiser Foundation Hospital Hospice - MartinezCCN 051552 · All quality measures

Ownership

Other

Certified

Jun 14, 1989

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

All disclosed owners & managing parties 19

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 2

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

• Anna Y. Bavykina, MD

  • Hospitalist Physician
  • Walnut Creek, CA
  • NPI 1467530535

  Contracted Managing Employee

  CMS ownership
• Regina M Benjamin, MD

  • Family Medicine Physician
  • Bayou la Batre, AL
  • NPI 1033188339

  Corporate Director

  CMS ownership

All facility ownership & control disclosures 79

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Facilities with the same owner 78

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

• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital San Diego

  • General Acute Care Hospital
  • San Diego, CA
  • NPI 1013062769

  Kaiser Foundation Hospitals

  CMS ownership
• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital Hospice Program

  • Community Based Hospice Care Agency
  • West Covina, CA
  • NPI 1053466953

  Kaiser Foundation Hospitals

  CMS ownership
• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital Inland Empire Hospice

  • Community Based Hospice Care Agency
  • Fontana, CA
  • NPI 1053466961

  Kaiser Foundation Hospitals

  CMS ownership
• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital Mental Health Ctr DP AHP

  • Psychiatric Hospital Unit
  • Los Angeles, CA
  • NPI 1063567956

  Kaiser Foundation Hospitals

  CMS ownership
• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital San Jose

  • General Acute Care Hospital
  • San Jose, CA
  • NPI 1063582989

  Kaiser Foundation Hospitals

  CMS ownership
• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital - Roseville

  • General Acute Care Hospital
  • Roseville, CA
  • NPI 1073811378

  Kaiser Foundation Hospitals

  CMS ownership
• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital Fresno

  • General Acute Care Hospital
  • Fresno, CA
  • NPI 1083784672

  Kaiser Foundation Hospitals

  CMS ownership
• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital Home Health Santa Rosa

  • Home Health Agency
  • Santa Rosa, CA
  • NPI 1104996933

  Kaiser Foundation Hospitals

  CMS ownership
• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital Los Angeles HHA

  • Home Health Agency
  • Pasadena, CA
  • NPI 1124173059

  Kaiser Foundation Hospitals

  CMS ownership
• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital West Los Angeles

  • General Acute Care Hospital
  • Los Angeles, CA
  • NPI 1134274897

  Kaiser Foundation Hospitals

  CMS ownership
• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital San Francisco

  • General Acute Care Hospital
  • San Francisco, CA
  • NPI 1134299522

  Kaiser Foundation Hospitals

  CMS ownership
• Kaiser Foundation Hospitals

  dba Kaiser Foundation Hospital - Orange County - Anaheim Medical Center

  • General Acute Care Hospital
  • Anaheim, CA
  • NPI 1144375056

  Kaiser Foundation Hospitals

  CMS ownership

Affiliated clinicians 2

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

• Sunitha R. Annamaneni, MD

  • Hospitalist Physician
  • Walnut Creek, CA
  • NPI 1992879209

  Hospice

  Care Compare affiliation
• Surekha Urva, MD

  • Internal Medicine Physician
  • Pleasanton, CA
  • NPI 1932287018

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618876800000",
    "number": "1053487793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 MUIR RD",
            "city": "MARTINEZ",
            "state": "CA",
            "postal_code": "945534614",
            "telephone_number": "925-229-7801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MUIR RD",
            "city": "MARTINEZ",
            "state": "CA",
            "postal_code": "945534614",
            "telephone_number": "925-229-7801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAISER FOUNDATION HOSPITALS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-27",
        "last_updated": "2021-04-20",
        "certification_date": "2021-04-20",
        "status": "A",
        "authorized_official_last_name": "MCKEOWN",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT, AREA MANAGER",
        "authorized_official_telephone_number": "925-295-5888",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "CA",
            "license": "070000571",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondingg",
            "affiliation": "N",
            "endpointDescription": "Carequality",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "200 Muir Rd",
            "city": "Martinez",
            "state": "CA",
            "country_code": "US",
            "postal_code": "945534614",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Kaiser Foundation Hospital Hospice - Martinez",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kaiser Foundation Hospital Hospice - Martinez",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Paul Juranovich, MFT
• Russell Paul Kageyama, DO
• Jonathan Kahn, MD
• Kaiser Foundation Health Plan Inc (Kaiser Health Plan Pediatric Phy)
• Kaiser Foundation Health Plan Inc (Kaiser Health Plan Mob Pharmacy 541)
• Kaiser Foundation Hospitals (Kaiser Foundation Hospital Home Health Martinez)
• Kaiser Foundation Hospitals (Kaiser Foundation Hospital Martinez Outpatient Peritoneal Dialysis Ut.)
• Kaiser Foundation Hospitals (Kaiser FDN HSP Inp Phy 54a)
• Kaiser Permanente
• Troy Kaji, M.D.

• Community Based Hospice Care Agency in Martinez, CA
• Providers in Martinez, CA by specialty
• Community Based Hospice Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2021; 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.