NPIMap

Organization Active NPI

Old Colony Hospice Inc

  • Family Nurse Practitioner
  • W Bridgewater, MA
National Provider Identifier
1144330002
Registry record updated Mar 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
7214 Issued in MA
Legal business name
OLD COLONY HOSPICE INC
Practice address
321 Manley St
W Bridgewater, MA 02379-1022
Phone
(781) 341-4145
Fax
(781) 297-7345
NPI assigned
Aug 30, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2023

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

Authorized official

Name
Toni Eaton
Title
Ceo
Phone
(781) 341-4145

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 7214 MA
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X 7214 MA Primary

Addresses

Primary practice location

321 Manley St
W Bridgewater, MA 02379-1022

Mailing address

One Credit Union Way
Randolph, MA 02368
Phone (781) 341-4145

Other identifiers 6

IdentifierTypeStateIssuer
0018209OtherNEIGHBORHOOD HEALTH PLAN
46302OtherAETNA
901570OtherTUFTS
700346OtherHOWARD PILGRIM
221514OtherBLUE CROSS BLUE SHIELD
0604593MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050711000039 MA Part A Provider - Hospice 4587611199 Practice locations: West Bridgewater, MA
O20070918000321 MA Part B Supplier - Clinic/Group Practice 4587611199 Receives reassigned benefits from 9 practitioners
1 other NPI on this enrollment
Practice locations: West Bridgewater, MA

Hospice certification: CCN 221514

Legal name
OLD COLONY HOSPICE INC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Aug 27, 1986
Last certification
Sep 2, 1999
Ownership / control type
Non-Profit - Private
Organization structure
CorporationNon-profit
Incorporated
Mar 26, 1980 in MA
Enrollment address
321 Manley St
West Bridgewater, MA 02379-1022

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Old Colony Hospice, IncCCN 221514
Ownership
Non-Profit
Certified
Aug 27, 1986
Medicare certification status
ActiveFrom the Provider of Services file

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
22D2106271Old Colony Hospice Inc321 Manley St, West Bridgewater, MA 02379Certificate of waiverMay 6, 2028

National Provider Directory

National Provider Directory

Locations

321 Manley St
West Bridgewater, MA 02379
Phone (781) 341-4145

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Melissa Clark Individual W-2 Managing Employee Dec 19, 2011
Operational/Managerial Control Dec 19, 2011
Paul McDonough Individual Corporate DirectorBoard Member Feb 1, 2018
John Finning Individual Corporate DirectorBoard Member May 1, 2017
Matthew Gilman Individual Corporate DirectorBoard Member Nov 1, 2018
John Camara II Individual Corporate DirectorBoard Member Feb 1, 2016
Valerie Sullivan Individual Corporate Director Oct 15, 2015
Martin McGovern Individual Corporate DirectorChairman Mar 9, 2011
John Manning Individual Corporate DirectorTreasurer Jan 27, 2012
Judith Cole Individual Corporate Director Aug 14, 2013
Marie McCarthy Individual Corporate DirectorBoard Member Aug 1, 2019
Kathrine Kelly Individual W-2 Managing EmployeeDirector of Operations & It Apr 26, 2015
Operational/Managerial ControlDirector of Operations & It Apr 26, 2015
Thoedore Flynn Individual Corporate DirectorVice Chairman Nov 6, 2013
Theodore D Ciolkosz Individual Corporate Director May 9, 2012
Anne Roan Individual Corporate DirectorBoard Member Aug 1, 2012
Leon G Josephs Individual Corporate DirectorClerk Jan 15, 2014
Toni L Eaton Individual Corporate OfficerPresident & Ceo Apr 14, 2011
Corporate DirectorPresident & Ceo Apr 14, 2011
W-2 Managing EmployeePresident & Ceo Apr 14, 2011
Operational/Managerial ControlPresident & Ceo Apr 14, 2011

Practitioners & affiliated clinicians

Practitioners 29

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

View all 29

Affiliated clinicians 81

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

View all 81

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680220800000",
    "number": "1144330002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ONE CREDIT UNION WAY",
            "city": "RANDOLPH",
            "state": "MA",
            "postal_code": "02368",
            "telephone_number": "781-341-4145",
            "fax_number": "781-297-7345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 MANLEY ST",
            "city": "W BRIDGEWATER",
            "state": "MA",
            "postal_code": "023791022",
            "telephone_number": "781-341-4145",
            "fax_number": "781-297-7345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD COLONY HOSPICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2023-03-31",
        "certification_date": "2023-03-31",
        "status": "A",
        "authorized_official_last_name": "EATON",
        "authorized_official_first_name": "TONI",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "781-341-4145"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MA",
            "license": "7214",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "7214",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NEIGHBORHOOD HEALTH PLAN",
            "identifier": "0018209",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "46302",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TUFTS",
            "identifier": "901570",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOWARD PILGRIM",
            "identifier": "700346",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "221514",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0604593",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in W Bridgewater, MA

Sources for this page

Verify at the official NPI Registry.