Active NPI
Bonita Springs Hospice Care LLC
- Community Based Hospice Care Agency
- Gilroy, CA
National Provider Identifier
1083014864
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- Legal business name
- BONITA SPRINGS HOSPICE CARE LLC
- Practice address
- 8545 Monterey St
Unit B
Gilroy, CA 95020-4273 - Phone
- (408) 848-1114
- Fax
- (408) 848-1115
- NPI assigned
- Aug 28, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Syeda Mamoona Omer, M.D
- Title
- Ceo/Administrator
- Phone
- (408) 848-1114
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Primary |
Addresses
Primary practice location
8545 Monterey St
Unit B
Gilroy, CA 95020-4273
Mailing address
8545 Monterey St
Unit-B
Gilroy, CA 95020-4273
Phone (408) 848-1114
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20141212001575 | CA | Part A Provider - Hospice | 2264754670 | Practice locations: Gilroy, CA |
Hospice certification: CCN 751672
- Legal name
- BONITA SPRINGS HOSPICE CARE LLC
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Oct 10, 2015
- Last certification
- Jun 16, 2021
- Ownership / control type
- Proprietary - Partnership
- Organization structure
- LLC
- Incorporated
- Sep 11, 2013 in CA
- Enrollment address
- 8545 Monterey St B
Gilroy, CA 95020-4273
Care Compare: Hospice
Medicare Care Compare- Listed as
- Bonita Springs Hospice Care LLC
- Ownership
- For-Profit
- Certified
- Oct 10, 2015
- Medicare certification status
- Active
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2100864 | Bonita Springs Hospice Care LLC | Certificate of waiver | Aug 23, 2027 |
National Provider Directory
National Provider DirectoryLocations
8545 Monterey St
Gilroy, CA 95020
Phone (408) 337-8117
8545 Monterey St
Ste B
Gilroy, CA 95020
Phone (408) 848-1114
Ownership & related parties
All disclosed owners & managing parties 2
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Syeda M Omer | 5% Or Greater Direct Ownership Interest | Sep 13, 2013 | 50% |
| Operational/Managerial Control | Sep 13, 2013 | 50% | |
| Mohammed O Qureshi | Corporate Officer | Sep 13, 2013 | 50% |
Practitioners & affiliated clinicians
Affiliated clinicians 9
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Geriatric Medicine (Family Medicine) Physician
- San Jose, CA
- NPI 1083994487
Hospice
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1409184000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1418256000000",
"number": "1083014864",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8545 MONTEREY ST",
"address_2": "UNIT-B",
"city": "GILROY",
"state": "CA",
"postal_code": "950204273",
"telephone_number": "408-848-1114",
"fax_number": "408-848-1115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8545 MONTEREY ST",
"address_2": "UNIT B",
"city": "GILROY",
"state": "CA",
"postal_code": "950204273",
"telephone_number": "408-848-1114",
"fax_number": "408-848-1115"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BONITA SPRINGS HOSPICE CARE LLC",
"organizational_subpart": "NO",
"enumeration_date": "2014-08-28",
"last_updated": "2014-12-11",
"status": "A",
"authorized_official_last_name": "OMER",
"authorized_official_first_name": "SYEDA",
"authorized_official_middle_name": "MAMOONA",
"authorized_official_title_or_position": "CEO/ADMINISTRATOR",
"authorized_official_telephone_number": "408-848-1114",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "M.D"
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gilroy, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2014; 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.