NPIMap

Organization Active NPI

Pediatric Services of America, LLC

  • Home Health Agency
  • Shelton, CT
National Provider Identifier
1104848134
Registry record updated Jan 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
C9612701 Issued in CT
Legal business name
PEDIATRIC SERVICES OF AMERICA, LLC
Practice address
1000 Bridgeport Ave Ste 309
Shelton, CT 06484-4660
Phone
(203) 381-1530
Fax
(203) 381-1535
NPI assigned
Jul 25, 2006
Reactivated
Apr 20, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2025

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

Authorized official

Name
Matthew Buckhalter
Title
Cfo
Phone
(470) 464-8000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X C9612701 CT Primary

Addresses

Primary practice location

1000 Bridgeport Ave Ste 309
Shelton, CT 06484-4660

Mailing address

400 Interstate North Pkwy SE Ste 1600
Atlanta, GA 30339-5047
Phone (470) 464-8000

Other practice location 1

146 New Britain Ave Ste 1
Plainville, CT 06062-2077
Phone (860) 747-3306

Other identifiers 2

IdentifierTypeStateIssuer
4187953MedicaidCT
004217304MedicaidCT

Other names 1

  • Aveanna Healthcare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070712000250 CT Part A Provider - Home Health Agency 5991614760 2 other NPIs on this enrollment
Practice locations: Plainville, CT; Shelton, CT

Home health agency certification: CCN 077199

Legal name
PEDIATRIC SERVICES OF AMERICA, LLC
Doing business as
AVEANNA HEALTHCARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Nov 18, 1993
Last certification
Jan 16, 2014
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Dec 28, 2020 in GA
Enrollment address
1000 Bridgeport Ave
Ste 309
Shelton, CT 06484-4669

Other NPIs with the same Medicare PAC ID 19

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

View all 19

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Aveanna HealthcareCCN 077199
Ownership
Proprietary
Certified
Nov 18, 1993
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
07D0877467Pediatric Services of America, LLC1000 Bridgeport Ave, Ste 309, Shelton, CT 06484Certificate of waiverOct 3, 2027

National Provider Directory

National Provider Directory
Tax ID family
Sleep Disorder Serv of76 organizations share this tax ID, including this one

Locations

146 New Britain Ave
Ste 1
Plainville, CT 06062
Phone (860) 747-3306

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
J.H. Whitney VII LP Organization, New Canaan, CT For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 16, 2017 16.09%
Psa Healthcare Investment Holding LLC Organization, New Canaan, CT LLC, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 16, 2017 8.04%
Aveanna Healthcare LLC Organization, Boston, MA Created for acquisition, LLC, For-profit, Chain home office, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 17, 2017 100%
Aveanna Healthcare Intermediate Holdings LLC Organization, Boston, MA Created for acquisition, LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 16, 2017 100%
Pediatric Services Holding LLC Organization, Atlanta, GA LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 30, 2020 100%
Aveanna Healthcare Holdings Inc Organization, Boston, MA Created for acquisition, Corporation, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 16, 2017 100%
Nut Tree Master Fund LP Organization, New York, NY For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 31, 2023 6.34%
Matthew Buckhalter Individual Corporate OfficerCfo Jul 7, 2023
Corporate DirectorCfo Jul 7, 2023
Laurie Ann Davis Individual W-2 Managing EmployeeAd; Sep 29, 2025
Bcip Associates IV US L.P. Organization, Boston, MA For-profit, Private equity company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 16, 2017 5.35%
Hamilton Lane Co-Investment Fund III Holdings - 2 LP Organization, Bala Cynwyd, PA For-profit, Private equity company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 16, 2017 7.5%
Deborah Stewart Individual Corporate DirectorDirector Jul 7, 2023
Bain Capital Fund XI LP Organization, Boston, MA For-profit, Private equity company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 16, 2017 35.54%
Psa Healthcare Intermediate Holding LLC Organization, Atlanta, GA LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 30, 2020 100%
Jerrold Perchik Individual Corporate OfficerSecretary Apr 29, 2024
Pediatric Services of America LLC Organization, Atlanta, GA LLC, Holding company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 30, 2020 100%
Bcpe Eagle Investor, L.P. Organization, Boston, MA Holding company, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 29, 2021 41.83%
Jeffrey Shaner Individual Corporate OfficerCeo Dec 1, 2015
Corporate DirectorCeo Jan 1, 2023
Pea Washington Holdings, LP Organization, Jersey City, NJ For-profit, Private equity company, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 29, 2021 5.45%

All facility ownership & control disclosures 7

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Aveanna HealthcareEnglewood, CO, CCN 067192 Home health agency 5% Or Greater Indirect Ownership Interest (100%) Sep 17, 2016
Thrive Skilled Pediatric CareScottsdale, AZ, CCN 037286 Home health agency 5% Or Greater Indirect Ownership Interest (100%) Jun 2, 2025
Aveanna HealthcareErie, PA, CCN 397310 Home health agency 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2016
Aveanna HealthcareLoveland, CO, CCN 067477 Home health agency 5% Or Greater Direct Ownership Interest (100%) Sep 26, 2020
Aveanna HealthcareWexford, PA, CCN 397278 Home health agency 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2016
Aveanna HealthcareWestminster, CO, CCN 067496 Home health agency 5% Or Greater Direct Ownership Interest (100%) Sep 26, 2020
Aveanna HealthcareDu Bois, PA, CCN 398190 Home health agency 5% Or Greater Direct Ownership Interest (100%) Feb 1, 2016

Owned or controlled facilities with NPI records 7

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 122

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

  • 5 Star Home Health Services, LLC
    • Home Health Agency
    • Orlando, FL
    • NPI 1376584730

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • 5 Star Home Health Services, LLC
    • Home Health Agency
    • Gainesville, FL
    • NPI 1518182773

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Andventure, LLC
    • Home Health Agency
    • Chambersburg, PA
    • NPI 1013150275

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Andventure, LLC
    • Home Health Agency
    • Phoenix, AZ
    • NPI 1013156470

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Andventure, LLC
    • Home Health Agency
    • Lancaster, PA
    • NPI 1093788002

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Andventure, LLC
    • Home Health Agency
    • State College, PA
    • NPI 1760621122

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Andventure, LLC
    • Home Health Agency
    • Springfield, MA
    • NPI 1881833259

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Angel'S Touch Home Care, LLC
    • Home Health Agency
    • West Pittston, PA
    • NPI 1376762237

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Care Unlimited Inc
    • Home Health Agency
    • Du Bois, PA
    • NPI 1811279540

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Care Unlimited Inc.
    • Home Health Agency
    • Wexford, PA
    • NPI 1407809114

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Care Unlimited Inc.
    • Home Health Agency
    • Erie, PA
    • NPI 1912101726

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
  • Comfort Care Coastal Home Health, LLC
    • Home Health Agency
    • Foley, AL
    • NPI 1740653047

    Aveanna Healthcare Holdings Inc, Aveanna Healthcare Intermediate Holdings LLC, Aveanna Healthcare LLC, Bain Capital Fund XI LP, Bcip Associates IV US L.P., Bcpe Eagle Investor, L.P., Hamilton Lane Co-Investment Fund III Holdings - 2 LP, J.H. Whitne

    CMS ownership
View all 122

NPI Registry JSON

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737936000000",
    "number": "1104848134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 INTERSTATE NORTH PKWY SE STE 1600",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303395047",
            "telephone_number": "470-464-8000",
            "fax_number": "770-248-8192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BRIDGEPORT AVE STE 309",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064844660",
            "telephone_number": "203-381-1530",
            "fax_number": "203-381-1535"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "146 New Britain Ave Ste 1",
            "address_purpose": "LOCATION",
            "city": "Plainville",
            "state": "CT",
            "postal_code": "060622077",
            "country_code": "US",
            "telephone_number": "860-747-3306",
            "fax_number": "860-747-4064",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PEDIATRIC SERVICES OF AMERICA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "deactivation_date": "2021-03-31",
        "reactivation_date": "2021-04-20",
        "status": "A",
        "authorized_official_last_name": "BUCKHALTER",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "470-464-8000"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "CT",
            "license": "C9612701",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4187953",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004217304",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aveanna Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shelton, CT

Sources for this page

Verify at the official NPI Registry.