Divinity Hospice, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

DIVINITY HOSPICE, LLC

Practice address

5601 Bridge St Ste 504
Fort Worth, TX 76112-2352

Phone

(817) 438-7463

Fax

(817) 438-7464

NPI assigned

Oct 8, 2019

Organization subpart

No

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

Authorized official

Name

Kathryn Elwess

Title

Cfo

Phone

(817) 438-7463

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Divinity Healthcare Doing business as

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Hospice certification: CCN 971560

Legal name

DIVINITY HOSPICE, LLC

Doing business as

DIVINITY HEALTHCARE

Certification status

Active

Provider type (POS)

Hospice

Participating since

May 13, 2020

Last certification

May 13, 2020

Ownership / control type

Proprietary - Corporation

Organization structure

LLCProprietary

Incorporated

Sep 19, 2019 in TX

Enrollment address

5601 Bridge St
Ste 504
Fort Worth, TX 76112-2352

Listed as

Divinity HealthcareCCN 971560

Ownership

For-Profit

Certified

May 13, 2020

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.

• Keith Douglas Rigsby, MD

  • Internal Medicine Physician
  • Ennis, TX
  • NPI 1952359622

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

  CMS ownership

Practitioners 1

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

• Keith Douglas Rigsby, MD

  • Internal Medicine Physician
  • Ennis, TX
  • NPI 1952359622
  NPD

Affiliated clinicians 3

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

• Anthony R Doti, MD

  • Internal Medicine Physician
  • Dallas, TX
  • NPI 1760403679

  Hospice

  Care Compare affiliation
• Keith Douglas Rigsby, MD

  • Internal Medicine Physician
  • Ennis, TX
  • NPI 1952359622

  Hospice

  Care Compare affiliation
• Della Mathew, MD

  • Internal Medicine Physician
  • Buffalo Grove, IL
  • NPI 1629028428

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1570492800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692230400000",
    "number": "1124660485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5601 BRIDGE ST STE 504",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761122352",
            "telephone_number": "817-438-7463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5601 BRIDGE ST STE 504",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761122352",
            "telephone_number": "817-438-7463",
            "fax_number": "817-438-7464"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINITY HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-08",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A",
        "authorized_official_last_name": "ELWESS",
        "authorized_official_first_name": "KATHRYN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "817-438-7463"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001032677",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Divinity Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Brian Jamel Dixon, M.D.

• All providers in Fort Worth, TX
• Community Based Hospice Care Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; 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.