NPIMap

Organization Active NPI

Silverleaf Hospice, Inc

Doing business as BridgeWay Palliative Care

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Watkinsville, GA
National Provider Identifier
1144770199
Registry record updated Oct 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Internal Medicine) PhysicianTaxonomy code 207RH0002X
License
108-0297-H Issued in GA
Legal business name
SILVERLEAF HOSPICE, INC
Doing business as
BridgeWay Palliative Care
Practice address
1731 Meriweather Dr
Suite 101
Watkinsville, GA 30677-7746
Phone
(706) 546-0286
Fax
(706) 546-0289
NPI assigned
Oct 13, 2016
Last updated
Oct 13, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2016

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

Authorized official

Name
Gary W Rasmussen
Title
President
Phone
(678) 932-6302

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X 108-0297-H GA Primary

Addresses

Primary practice location

1731 Meriweather Dr
Suite 101
Watkinsville, GA 30677-7746

Mailing address

1395 S Marietta Pkwy SE
BLDG 400 Suite 116
Marietta, GA 30067-4440
Phone (678) 932-6302

Other names 1

  • BridgeWay Palliative Care Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161227000172 GA Part B Supplier - Clinic/Group Practice 6800966979 Receives reassigned benefits from 4 practitioners
Practice locations: Athens, GA

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Silverleaf Hospice Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

705 Whitehead Rd
Athens, GA 30606
Phone (706) 549-9800

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Affinity HospiceAthens, GA, CCN 111676 Hospice 5% Or Greater Direct Ownership Interest (100%) Sep 21, 2016

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1476316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476316800000",
    "number": "1144770199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1395 S MARIETTA PKWY SE",
            "address_2": "BLDG 400 SUITE 116",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300674440",
            "telephone_number": "678-932-6302",
            "fax_number": "678-402-5246"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1731 MERIWEATHER DR",
            "address_2": "SUITE 101",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306777746",
            "telephone_number": "706-546-0286",
            "fax_number": "706-546-0289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SILVERLEAF HOSPICE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-13",
        "last_updated": "2016-10-13",
        "status": "A",
        "authorized_official_last_name": "RASMUSSEN",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-932-6302"
    },
    "taxonomies": [
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": "GA",
            "license": "108-0297-H",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BridgeWay Palliative Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Watkinsville, GA

Sources for this page

Verify at the official NPI Registry.