The Lighthouse Community Hospice Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

THE LIGHTHOUSE COMMUNITY HOSPICE INC

Practice address

1029 Meredith Park Dr
McDonough, GA 30253-7557

Phone

(678) 759-1960

Fax

(678) 623-3455

NPI assigned

Jan 23, 2020

Last updated

Jan 23, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Jocelyn Campbell

Title

Administrator

Phone

(678) 759-1960

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1134759764. Details of each certification follow.

• CCN 851528 Hospice · Active · Details

Hospice certification: CCN 851528

Legal name

THE LIGHTHOUSE COMMUNITY HOSPICE INC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Jun 17, 2020

Last certification

Jun 17, 2020

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Sep 5, 2019 in GA

Enrollment address

1029 Meredith Park Dr
McDonough, GA 30253-7557

Listed as

Lighthouse Community Hospice, theCCN 851528 · All quality measures

Ownership

For-Profit

Certified

Jun 17, 2020

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 2

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.

• Carol M Odegaard, M.D.

  • Family Medicine Physician
  • Jackson, GA
  • NPI 1700876554

  Contracted 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, and the practitioner matching its NPPES authorized official.

• Carol M Odegaard, M.D.

  • Family Medicine Physician
  • Jackson, GA
  • NPI 1700876554
  NPD (past)

Affiliated clinicians 1

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

• Carol M Odegaard, M.D.

  • Family Medicine Physician
  • Jackson, GA
  • NPI 1700876554

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1579737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579737600000",
    "number": "1134759764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1029 MEREDITH PARK DR",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302537557",
            "telephone_number": "678-759-1960",
            "fax_number": "678-623-3455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1029 MEREDITH PARK DR",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302537557",
            "telephone_number": "678-759-1960",
            "fax_number": "678-623-3455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LIGHTHOUSE COMMUNITY HOSPICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-23",
        "last_updated": "2020-01-23",
        "certification_date": "2020-01-23",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "JOCELYN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "678-759-1960",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2020; 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.