NPIMap

Organization Active NPI

Beth Israel Deaconess Hospital Plymouth, Inc.

Doing business as Cranberry Hospice

  • Community Based Hospice Care Agency
  • Plymouth, MA
National Provider Identifier
1164535084
Registry record updated Mar 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
7221 Issued in MA
Legal business name
BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC.
Doing business as
Cranberry Hospice
Practice address
36 Cordage Park Cir
Suite 326
Plymouth, MA 02360-7331
Phone
(508) 746-0215
Fax
(508) 830-3336
NPI assigned
Aug 16, 2006
Last updated
Mar 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2021

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

Authorized official

Name
Jason M Radzevich
Title
V.P. of Finance and Cfo
Phone
(508) 830-2005

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 7221 MA Primary

Addresses

Primary practice location

36 Cordage Park Cir
Suite 326
Plymouth, MA 02360-7331

Mailing address

275 Sandwich St
Plymouth, MA 02360-2183
Phone (508) 746-2000

Other names 1

  • Cranberry Hospice Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050321000212 MA Part B Supplier - Clinic/Group Practice 8224947536 Receives reassigned benefits from 4 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Plymouth, MA
O20050825000311 MA Part A Provider - Hospice 8224947536 3 other NPIs on this enrollment
Practice locations: Plymouth, MA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164535084. Details of each certification follow.

Hospice certification: CCN 221520B

Legal name
BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH INC
Doing business as
CRANBERRY HOSPICE
Organization structure
CorporationNon-profit
Incorporated
Oct 26, 1984 in MA
Enrollment address
275 Sandwich St
East Building 1St Floor
Plymouth, MA 02360-2183

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Cranberry HospiceCCN 221520
Ownership
Non-Profit
Certified
Jun 23, 1988
Medicare certification status
ActiveFrom the Provider of Services file

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address. The facility is not in the current Medicare enrollment files, which can mean its Medicare enrollment has ended (or, for VA and military hospitals, that it does not enroll).

National Provider Directory

National Provider Directory
Tax ID family
Jordan Hospital Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 22

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

NameRoleSinceShare
Jamie Katz Individual Corporate DirectorClerk Jan 1, 2014
Kevin M Tabb Individual Corporate DirectorBoard Member & Pres. and Ceo Bilh Jan 1, 2014
Keelas Small Individual Corporate Director Nov 17, 2008
Beth Israel Lahey Health, Inc. Organization, Boston, MA Non-profit 5% Or Greater Direct Ownership Interest Mar 1, 2019 100%
Thomas a Browning Individual Contracted Managing EmployeeMD; Nov 1, 2015
Nicole Marie Mulkern Individual Corporate Officer Apr 19, 2022
Joshua W Stuhlfaut Individual Corporate Director Sep 19, 2017
William Gagnon Individual Corporate Director Sep 18, 2013
Mary Ellen Lawrence Individual Corporate Director Apr 29, 2015
Stephen P Fischer Individual Corporate DirectorTreasurer Jan 1, 2014
John Carnuccio Individual Corporate Director Jun 2, 2008
Charles Hewitt Individual Corporate Director Jan 31, 2018
Kenneth Fosdick Individual Corporate Director Nov 18, 2002
Catherine Grey Individual W-2 Managing Employee Aug 1, 1998
Clark Hinkley Individual Corporate Director Nov 15, 2004
David M Kelly Individual Corporate Director Jan 1, 2019
Kimberly a Lonis-Scheub Individual Corporate Director Nov 7, 2008
Michael Babini Individual Corporate Director Jun 2, 2008
Kevin B Coughlin Individual Corporate OfficerPresident Jun 12, 2017
W-2 Managing EmployeePresident Sep 2, 2014
Lyle Bazzinotti Individual Corporate Director Nov 18, 2002
Deborah Dolaway Individual W-2 Managing EmployeeAd; Apr 1, 1987
Stephen M Trehu Individual Corporate Director Nov 16, 2009

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 18

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 18

Practitioners & affiliated clinicians

Affiliated clinicians 41

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

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616457600000",
    "number": "1164535084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 SANDWICH ST",
            "city": "PLYMOUTH",
            "state": "MA",
            "postal_code": "023602183",
            "telephone_number": "508-746-2000",
            "fax_number": "508-830-1131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36 CORDAGE PARK CIR",
            "address_2": "SUITE 326",
            "city": "PLYMOUTH",
            "state": "MA",
            "postal_code": "023607331",
            "telephone_number": "508-746-0215",
            "fax_number": "508-830-3336"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-16",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A",
        "authorized_official_last_name": "RADZEVICH",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "V.P. OF FINANCE AND CFO",
        "authorized_official_telephone_number": "508-830-2005"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MA",
            "license": "7221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cranberry Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cranberry Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plymouth, MA

Sources for this page

Verify at the official NPI Registry.