Southern Grace Hospice North LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

SOUTHERN GRACE HOSPICE NORTH LLC

Practice address

510 E Morris Ave
Hammond, LA 70403-4352

Phone

(985) 277-1945

Fax

(985) 277-1946

NPI assigned

Dec 11, 2024

Organization subpart

No

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

Authorized official

Name

Timothy A Bergeron

Title

Ceo

Phone

(985) 264-3940

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

Hospice certification: CCN 191644

Legal name

SOUTHERN GRACE HOSPICE NORTH LLC

Doing business as

SOUTHERN GRACE HOSPICE

Certification status

Active

Provider type (POS)

Hospice

Participating since

Oct 15, 2007

Last certification

Nov 13, 2020

Ownership / control type

Proprietary - Other

Organization structure

LLCProprietary

Enrollment address

510 E Morris Ave
Hammond, LA 70403-4352

Listed as

Southern Grace HospiceCCN 191644

Ownership

Other

Certified

Oct 15, 2007

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

Locations

All disclosed owners & managing parties 8

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.

• Kyle Lance Caulfield, MD

  • Internal Medicine Physician
  • Hammond, LA
  • NPI 1164420162

  Contracted Managing Employee

  CMS ownership
• Ashley Hillman

  • Professional Counselor
  • West Peoria, IL
  • NPI 1346041837

  Operational/Managerial Control

  CMS ownership

Facilities with the same owner 1

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

• Southern Grace Hospice West LLC

  • Community Based Hospice Care Agency
  • Lafayette, LA
  • NPI 1194532341

  Southern Grace Management LLC

  CMS ownership

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• Canon Hospice-North Shore, LLC

  • Community Based Hospice Care Agency
  • Mandeville, LA
  • NPI 1881805059

  Acquired from, 2024-12-04

  CMS change of ownership

Affiliated clinicians 3

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

• Kyle Lance Caulfield, MD

  • Internal Medicine Physician
  • Hammond, LA
  • NPI 1164420162

  Hospice

  Care Compare affiliation
• Riza Cruz, M.D.

  • Family Medicine Physician
  • Baton Rouge, LA
  • NPI 1174933030

  Hospice

  Care Compare affiliation
• James K Ellis, M.D.

  • Hematology & Oncology Physician
  • Thibodaux, LA
  • NPI 1982792750

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1733875200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733875200000",
    "number": "1093522245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "458A HEYMANN BLVD BLDG A",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705032617",
            "telephone_number": "337-366-8505",
            "fax_number": "337-366-8565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 E MORRIS AVE",
            "city": "HAMMOND",
            "state": "LA",
            "postal_code": "704034352",
            "telephone_number": "985-277-1945",
            "fax_number": "985-277-1946"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN GRACE HOSPICE NORTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-12-11",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A",
        "authorized_official_last_name": "BERGERON",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "985-264-3940"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southeast Louisiana Veterans Health Care System
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• Southeast Mental Health LLC
• Southeastern Louisiana Univerisity
• Southeastern Louisiana University
• Southern Medical
• Southern Neurointerventional Institute
• Lauren Marie Sowyers
• Matthew Spano
• Gerald J Sparks, MD

• Community Based Hospice Care Agency in Hammond, LA
• Providers in Hammond, LA by specialty
• Community Based Hospice Care Agency in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2024; 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.