NPIMap

Organization Active NPI

Main Street Hospice, LLC

  • Community Based Hospice Care Agency
  • Franklin, IN
National Provider Identifier
1063470946
Registry record updated May 19, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
050091241 Issued in IN
Legal business name
MAIN STREET HOSPICE, LLC
Practice address
10 Highland Ave
Franklin, IN 46131-1230
Phone
(317) 736-0055
Fax
(317) 739-3505
NPI assigned
May 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2021

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

Authorized official

Name
Douglas Weddle
Title
Cfo
Phone
(317) 736-0055

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 050091241 IN Primary

Addresses

Primary practice location

10 Highland Ave
Franklin, IN 46131-1230

Mailing address

10 Highland Ave
Franklin, IN 46131-1230
Phone (317) 736-0055

Other identifiers 1

IdentifierTypeStateIssuer
300020428MedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181011001329 IN Part A Provider - Hospice 4587916002 Practice locations: Franklin, IN

Hospice certification: CCN 151540

Legal name
MAIN STREET HOSPICE LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jan 11, 1996
Last certification
Jul 12, 2019
Ownership / control type
Proprietary - Individual
Organization structure
LLCProprietary
Incorporated
Mar 12, 2018 in IN
Enrollment address
10 Highland Ave
Franklin, IN 46131-1230

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Main Street Hospice, LLCCCN 151540 · All quality measures
Ownership
For-Profit
Certified
Jan 11, 1996
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Americare Home Health Servicesinc2 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.

Locations

1150 N Main St
Apt A
Franklin, IN 46131
Phone (317) 736-0055

1739 N Shadeland Ave
Indianapolis, IN 46219
Phone (317) 358-2300

Ownership & related parties

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.

NameRoleSinceShare
Kimberly Weddle Individual W-2 Managing EmployeeAdmin Aug 10, 2018
Douglas K Weddle Individual 5% Or Greater Direct Ownership Interest Aug 10, 2018 50%
Corporate OfficerCfo Aug 10, 2018 50%
George M Cornett Individual 5% Or Greater Direct Ownership Interest Aug 10, 2018 50%

Owners & managing parties with NPI records 1

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

Change-of-ownership history 2

DateEventCounterparty
Aug 10, 2018 Change of OwnershipThis provider was the buyer Americare HospiceCCN 151540, IN, NPI 1063470946
Aug 10, 2018 Change of OwnershipThis provider was the seller Main Street Hospice LLCCCN 151540, IN, NPI 1063470946

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 7

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": "1146528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1621382400000",
    "number": "1063470946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 HIGHLAND AVE",
            "city": "FRANKLIN",
            "state": "IN",
            "postal_code": "461311230",
            "telephone_number": "317-736-0055",
            "fax_number": "317-739-3505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 HIGHLAND AVE",
            "city": "FRANKLIN",
            "state": "IN",
            "postal_code": "461311230",
            "telephone_number": "317-736-0055",
            "fax_number": "317-739-3505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-02",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-19",
        "status": "A",
        "authorized_official_last_name": "WEDDLE",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "317-736-0055"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "IN",
            "license": "050091241",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300020428",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Franklin, IN

Sources for this page

Verify at the official NPI Registry.