The Hospice of San Diego

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

THE HOSPICE OF SAN DIEGO

Practice address

12616 Sora Way
San Diego, CA 92129-4145

Phone

(858) 699-3445

Fax

(858) 538-6412

NPI assigned

Nov 3, 2017

Last updated

Nov 3, 2017By 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. Myrna Miteria Rodillon, RN

Title

Administrator/DPCS

Phone

(858) 699-3445

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093227738. Details of each certification follow.

• CCN A01664 Hospice · Active · Details

Hospice certification: CCN A01664

Legal name

THE HOSPICE OF SAN DIEGO

Doing business as

HOSPICE ENGINE

Certification status

Active

Provider type (POS)

Hospice

Participating since

Nov 25, 2019

Last certification

Nov 25, 2019

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Mar 10, 2017 in CA

Enrollment address

12975 Brookprinter PL
Ste 150
Poway, CA 92064-8895

Listed as

The Hospice of San DiegoCCN A01664 · All quality measures

Ownership

For-Profit

Certified

Nov 25, 2019

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 5

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 1

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

• Irene-Nicole Miteria Lucero, MSN, FNP-BC

  • Family Nurse Practitioner
  • San Diego, CA
  • NPI 1598275307

  5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, Operational/Managerial Control, W-2 Managing Employee

  CMS ownership

Affiliated clinicians 1

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

• Michael Larry Cutler, M.D.

  • Adult Medicine Physician
  • Poway, CA
  • NPI 1871620518

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1509667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1509667200000",
    "number": "1093227738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12616 SORA WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921294145",
            "telephone_number": "858-699-3445",
            "fax_number": "858-538-6412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12616 SORA WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921294145",
            "telephone_number": "858-699-3445",
            "fax_number": "858-538-6412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE HOSPICE OF SAN DIEGO",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-03",
        "last_updated": "2017-11-03",
        "status": "A",
        "authorized_official_last_name": "RODILLON",
        "authorized_official_first_name": "MYRNA",
        "authorized_official_middle_name": "MITERIA",
        "authorized_official_title_or_position": "ADMINISTRATOR/DPCS",
        "authorized_official_telephone_number": "858-699-3445",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in San Diego, 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 Nov 3, 2017; 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.