Southern Grace Hospice and Palliative Care

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

SOUTHERN GRACE HOSPICE AND PALLIATIVE CARE

Practice address

80 Candler Rd
McDonough, GA 30253-5455

Phone

(678) 432-8811

Fax

(678) 432-8821

NPI assigned

Apr 17, 2014

Organization subpart

No

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

Authorized official

Name

Aubrey M Kekiwi

Title

Ceo

Phone

(678) 432-8811

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in GA2 enrollments

Enrollment records 2

Hospice certification: CCN 111750

Legal name

SOUTHERN GRACE HOSPICE AND PALLIATIVE CARE

Certification status

Active

Provider type (POS)

Hospice

Participating since

Aug 28, 2014

Last certification

Jun 13, 2019

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Mar 8, 2014 in GA

Enrollment address

80 Candler Rd
McDonough, GA 30253-5455

Listed as

Southern Grace Hospice and Palliative CareCCN 111750

Ownership

For-Profit

Certified

Aug 28, 2014

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 3

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.

• Mobin Shah, MD

  • Hospitalist Physician
  • Fayetteville, GA
  • NPI 1932319613

  Contracted Managing Employee

  CMS ownership

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Heather Whyte Haymes-Payne, NP

  • Primary Care Nurse Practitioner
  • Peachtree Corners, GA
  • NPI 1184110587
  Medicare reassignment NPD
• Mobin Shah, MD

  • Hospitalist Physician
  • Fayetteville, GA
  • NPI 1932319613

  Family Medicine

  Medicare reassignment NPD
• Heather Marie Mathis, FNP-C

  • Family Nurse Practitioner
  • McDonough, GA
  • NPI 1639470206
  NPD

Affiliated clinicians 3

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

• Paul L Harvey, MD

  • Internal Medicine Physician
  • Riverdale, GA
  • NPI 1053410357

  Hospice

  Care Compare affiliation
• Ellis Mossaded, M.D.

  • General Practice Physician
  • Gainesville, GA
  • NPI 1790195261

  Hospice

  Care Compare affiliation
• Mobin Shah, MD

  • Hospitalist Physician
  • Fayetteville, GA
  • NPI 1932319613

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1397692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726617600000",
    "number": "1124448188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "80 CANDLER RD",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302535455",
            "telephone_number": "678-432-8811",
            "fax_number": "678-432-8821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 CANDLER RD",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302535455",
            "telephone_number": "678-432-8811",
            "fax_number": "678-432-8821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN GRACE HOSPICE AND PALLIATIVE CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-17",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A",
        "authorized_official_last_name": "KEKIWI",
        "authorized_official_first_name": "AUBREY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "678-432-8811"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "aubrey@southerngracehospice.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "80 Candler Rd",
            "city": "McDonough",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302535455",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "aubrey@southerngracehospice.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "80 Candler Rd",
            "city": "McDonough",
            "state": "GA",
            "country_code": "US",
            "postal_code": "302535455",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Community Based Hospice Care Agency in McDonough, GA
• Providers in McDonough, GA by specialty
• Community Based Hospice Care Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 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.