NPIMap

Organization Active NPI

Authoracare Collective

  • Community Based Hospice Care Agency
  • Greensboro, NC
National Provider Identifier
1093774614
Registry record updated May 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
HC0374 Issued in NC
Legal business name
AUTHORACARE COLLECTIVE
Practice address
2500 Summit Ave
Greensboro, NC 27405-4522
Phone
(336) 621-2500
Fax
(336) 621-4516
NPI assigned
Mar 22, 2006
Last updated
May 6, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 6, 2020

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

Authorized official

Name
Mrs. Kristen Wither Yntema, MBA, MHSA
Title
Ceo
Phone
(336) 621-2500

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X HC0374 NC
Community Based Hospice Care Agency 251G00000X HC0374 NC Primary

Addresses

Primary practice location

2500 Summit Ave
Greensboro, NC 27405-4522

Mailing address

2500 Summit Ave
Greensboro, NC 27405-4522
Phone (336) 621-2500

Other identifiers 10

IdentifierTypeStateIssuer
0021TOtherNCBCBS HOSPICE
2630370OtherNCUHC-PALLIATIVE CARE ASSOC
3407128MedicaidNC
6003656OtherNCUHC-HOMEHEALTH
83-00808OtherNCUHC-HOSPICE
3409253MedicaidNC
3401503MedicaidNC
0074BOtherNCBCBS-HOMEHEALTH
56162OtherNCGP MEDCOST-PALIATIVE CAR
5904287MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040621001772 NC Part B Supplier - Clinic/Group Practice 3678558962 Receives reassigned benefits from 26 practitioners
2 other NPIs on this enrollment
Practice locations: Greensboro, NC
O20080109000122 NC Part A Provider - Hospice 3678558962 Practice locations: Burlington, NC; Greensboro, NC
O20090611000768 NC Part A Provider - Home Health Agency 3678558962 Practice locations: Burlington, NC; Greensboro, NC

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1093774614. Details of each certification follow.

Hospice certification: CCN 341503

Legal name
AUTHORACARE COLLECTIVE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 14, 1985
Last certification
Aug 12, 2004
Ownership / control type
Non-Profit - Private
Organization structure
CorporationNon-profit
Incorporated
Sep 10, 1984 in NC
Enrollment address
2500 Summit Ave
Greensboro, NC 27405-4522

Home health agency certification: CCN 347128

Legal name
AUTHORACARE COLLECTIVE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Oct 4, 1985
Last certification
Aug 2, 2007
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
Sep 10, 1984 in NC
Enrollment address
2500 Summit Ave
Greensboro, NC 27405-4522

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Home health agency

Medicare Care Compare
Listed as
Authoracare CollectiveCCN 347128 · All quality measures
Overall star rating
3.5 of 5
Ownership
Non-Profit
Certified
Oct 4, 1985
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Care Compare: Hospice

Medicare Care Compare
Listed as
Authoracare CollectiveCCN 341503 · All quality measures
Ownership
Non-Profit
Certified
Jun 14, 1985
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Hospice at Greensboro Inc2 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

2500 Summit Ave
Greensboro, NC 27405
Phone (336) 621-2500

Ownership & related parties

All disclosed owners & managing parties 22

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Andrew Edward Barrow Individual Corporate Director Oct 1, 2022
Mary Lee Wood Copeland Individual Corporate Director Oct 1, 2015
Rebekah Loy Individual Corporate OfficerSecretary Treasurer Oct 1, 2019
Corporate OfficerSecretary/Treasurer Oct 1, 2019
Tiffany D Morris Individual Corporate Director Apr 15, 2022
Corporate DirectorBoard Member Apr 15, 2022
Juan-Carlos Monguilod Individual W-2 Managing Employee Nov 14, 2005
Timothy Finnegan Individual Corporate Director Oct 1, 2022
Ajay Bhardwaj Individual Corporate Director Oct 1, 2023
The Moses H. Cone Memorial Hospital Organization, Greensboro, NC Non-profit 5% Or Greater Direct Ownership Interest Oct 1, 1984 50%
Christopher Cornue Individual Corporate Director Oct 1, 2023
Leigh Spencer Williams Individual Corporate OfficerCfo May 16, 2022
Corporate Officer May 16, 2022
Corporate Director May 16, 2022
W-2 Managing Employee May 16, 2022
Barbara Ellen Pancoast Individual Corporate Director Oct 1, 2015
Mary Clare Toomey Individual Corporate Director Dec 1, 2022
Ike David Kibee Individual Corporate DirectorBoard Member Apr 1, 2021
Corporate Director Apr 1, 2021
Elizabeth Brantley Bostian Individual Corporate Director Oct 1, 2023
Phanta Iman Lansden Individual Corporate Director Oct 1, 2023
Devin Griffith Individual Corporate Director Oct 1, 2023
W-2 Managing Employee Feb 17, 2020
Sendil K Krishnan Individual Corporate Director Mar 29, 2022
Corporate DirectorBoard Member Mar 29, 2022
Ryan Addison Newkirk Individual Corporate Director Oct 1, 2023
Mark Gordon Individual Corporate Director Oct 1, 2023
Laura Wilson Murray Individual Corporate DirectorBoard Member Apr 1, 2021
Corporate Director Apr 1, 2021
Kristen W Yntema Individual W-2 Managing EmployeePresident and Ceo Mar 4, 2017
Corporate OfficerCeo Mar 3, 2017
W-2 Managing EmployeePresident and Ceo Mar 3, 2017
Ronald P Johnson Individual Corporate Director Oct 1, 2014

Owners & managing parties with NPI records 4

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

Facilities with the same owner 5

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

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 38

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 38

Affiliated clinicians 61

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

View all 61

NPI Registry JSON

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

{
    "created_epoch": "1142985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588723200000",
    "number": "1093774614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 SUMMIT AVE",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274054522",
            "telephone_number": "336-621-2500",
            "fax_number": "336-621-4516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 SUMMIT AVE",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274054522",
            "telephone_number": "336-621-2500",
            "fax_number": "336-621-4516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTHORACARE COLLECTIVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-22",
        "last_updated": "2020-05-06",
        "certification_date": "2020-05-06",
        "status": "A",
        "authorized_official_last_name": "YNTEMA",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_middle_name": "WITHER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "336-621-2500",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MBA, MHSA"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NC",
            "license": "HC0374",
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NC",
            "license": "HC0374",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS HOSPICE",
            "identifier": "0021T",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC-PALLIATIVE CARE ASSOC",
            "identifier": "2630370",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3407128",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC-HOMEHEALTH",
            "identifier": "6003656",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC-HOSPICE",
            "identifier": "83-00808",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3409253",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3401503",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-HOMEHEALTH",
            "identifier": "0074B",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GP MEDCOST-PALIATIVE CAR",
            "identifier": "56162",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5904287",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greensboro, NC

Sources for this page

Verify at the official NPI Registry.