Southeast Hospice, LLC,

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

121-0416-H Issued in GA

Legal business name

SOUTHEAST HOSPICE, LLC,

Practice address

1203 George C. Wilson Drive Suite a
Augusta, GA 30909-4502

Phone

(706) 364-3108

Fax

(706) 364-3315

NPI assigned

Jun 8, 2015

Organization subpart

No

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

Authorized official

Name

Stuart Prather

Title

Administrator

Phone

(706) 364-3108

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Southeast Hospice Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Hospice certification: CCN 111769

Legal name

SOUTHEAST HOSPICE, LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Oct 30, 2015

Last certification

Oct 27, 2021

Ownership / control type

Proprietary - Corporation

Organization structure

LLCProprietary

Incorporated

Feb 1, 2015 in GA

Enrollment address

3736 Executive Center Dr
Martinez, GA 30907-2360

Listed as

Southeast HospiceCCN 111769

Ownership

For-Profit

Certified

Oct 30, 2015

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 5

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.

• Stephen Lewis Schmidt, M.D.

  • Family Medicine Physician
  • Evans, GA
  • NPI 1790784593

  5% Or Greater Direct Ownership Interest, General Partnership Interest, W-2 Managing Employee

  CMS ownership

Affiliated clinicians 2

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

• George Clark Pursley, MD

  • Internal Medicine Physician
  • Martinez, GA
  • NPI 1093758724

  Hospice

  Care Compare affiliation
• Stephen Lewis Schmidt, M.D.

  • Family Medicine Physician
  • Evans, GA
  • NPI 1790784593

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1433721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486684800000",
    "number": "1144600875",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1203 GEORGE C. WILSON DRIVE SUITE A",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309094502",
            "telephone_number": "706-364-3108",
            "fax_number": "706-364-3315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1203 GEORGE C. WILSON DRIVE SUITE A",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309094502",
            "telephone_number": "706-364-3108",
            "fax_number": "706-364-3315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST HOSPICE, LLC,",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-08",
        "last_updated": "2017-02-10",
        "status": "A",
        "authorized_official_last_name": "PRATHER",
        "authorized_official_first_name": "STUART",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "706-364-3108"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "GA",
            "license": "121-0416-H",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GA HOSPICE LICENSE",
            "identifier": "121-0416-H",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southeast Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Anas Souid, MD
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• South Path, P.C.
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• Southeast Retina Center PC
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• Southern Anesthesia of Augusta LLC
• Southern Eye Clinic P.C.

• Community Based Hospice Care Agency in Augusta, GA
• Providers in Augusta, 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 Feb 10, 2017; 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.