Beth Israel Deaconess Hospital Plymouth, Inc.
Organization Active NPI Community Based Hospice Care Agency · Plymouth, MA
NPI 1164535084 · NPPES record last updated Mar 23, 2021
Key facts
- NPI
- 1164535084
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- License
- 7221 (MA)
- Legal business name
- BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH, INC.
- 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
- Organization subpart
- No
Authorized official
- Name
- Jason M Radzevich
- Title
- V.P. of Finance and Cfo
- Phone
- (508) 830-2005
Owners & managing parties with NPI records 3
-
Thomas Browning, M.D.
-
David Kelly, MD
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 2
Member organizations 3
Facilities with the same owner 18
Affiliated clinicians 41
-
Margaret T Anastasi, ANP
-
Arthur Ralph Bregoli Jr., M.D.
-
Thomas Caughey, MD
-
David Chiang, M.D
-
Samridhi Chikersal, M.D
-
Stephanie Cody, MD
-
Karri A. Crowley, FNP
-
Emily Domingue, MD
-
Mark J Eubanks, M.D.
-
Brian P. Fitzpatrick, M.D.
-
Robert Edward Gaudet Jr., M.D.
-
David Grace, M.D.
-
William Griever, M.D.
-
Zachary Nathan Gross, M.D.
-
Irina Gurevich, M.D.
-
Charles C Harootunian, D.O.
-
Andrea Maria Jodat, FNP
-
Eric E Johnson, MD
-
Stephen Kaplan, M.D.
-
Ulrike B Kohler, M.D.
-
James Matthew Koomey, M.D.
-
Deborah J Kylander, M.D.
Medicare Care Compare: Hospice
- Listed as
- Cranberry Hospice
- Ownership
- Non-Profit
- Certified
- Jun 23, 1988
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MA
Hospice certification: CCN 221520B
- Legal name
- BETH ISRAEL DEACONESS HOSPITAL PLYMOUTH INC
- Doing business as
- CRANBERRY HOSPICE
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 26, 1984 in MA
- Enrollment address
- 275 Sandwich St
East Building 1St Floor
Plymouth, MA 02360-2183
All disclosed owners & managing parties 22
| Name | Role | Since | Share |
|---|---|---|---|
| Jamie Katz |
Corporate Director |
Jan 1, 2014 | |
| Kevin M Tabb |
Corporate Director |
Jan 1, 2014 | |
| Keelas Small |
Corporate Director | Nov 17, 2008 | |
| Beth Israel Lahey Health, Inc. |
5% Or Greater Direct Ownership Interest | Mar 1, 2019 | 100% |
| Thomas a Browning |
Contracted Managing Employee |
Nov 1, 2015 | |
| Nicole Marie Mulkern |
Corporate Officer | Apr 19, 2022 | |
| Joshua W Stuhlfaut |
Corporate Director | Sep 19, 2017 | |
| William Gagnon |
Corporate Director | Sep 18, 2013 | |
| Mary Ellen Lawrence |
Corporate Director | Apr 29, 2015 | |
| Stephen P Fischer |
Corporate Director |
Jan 1, 2014 | |
| John Carnuccio |
Corporate Director | Jun 2, 2008 | |
| Charles Hewitt |
Corporate Director | Jan 31, 2018 | |
| Kenneth Fosdick |
Corporate Director | Nov 18, 2002 | |
| Catherine Grey |
W-2 Managing Employee | Aug 1, 1998 | |
| Clark Hinkley |
Corporate Director | Nov 15, 2004 | |
| David M Kelly |
Corporate Director | Jan 1, 2019 | |
| Kimberly a Lonis-Scheub |
Corporate Director | Nov 7, 2008 | |
| Michael Babini |
Corporate Director | Jun 2, 2008 | |
| Kevin B Coughlin |
Corporate Officer |
Jun 12, 2017 | |
| W-2 Managing Employee |
Sep 2, 2014 | ||
| Lyle Bazzinotti |
Corporate Director | Nov 18, 2002 | |
| Deborah Dolaway |
W-2 Managing Employee |
Apr 1, 1987 | |
| Stephen M Trehu |
Corporate Director | Nov 16, 2009 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Tax ID family
- Cranberry Hospice
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 7221 | MA | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0608556 | Medicaid | MA | |
| 221520 | Other | MA | BCBS MA CRANBERRY HOSPICE |
| S012236 | Other | MA | CHAMPUS |
| 000000020545 | Other | MA | BMC HEALTHNET |
| 819809 | Other | MA | TUFTS CRANBERRY HOSP-2 |
| 221520B | Other | MA | MEDICARE PTAN CRANBERRY HOSPICE |
| AA50951 | Other | MA | HPHC CRANBERRY HOSPICE |
Other names
- Cranberry Hospice
Other providers in Plymouth, MA
- Margaret Ann Bertocchi-Hall
- Alyssa Bertoni
- Tayler Bessette
- Beth Israel Deaconess Hospital Plymouth, Inc.
- Beth Israel Deaconess Hospital Plymouth, Inc.
- Beth Israel Lahey Health Surgery Center Plymouth LLC
- Bethany Ison Licsw, LLC
- David Betteridge
- Nicholas Biagini
- Charles Bichajian
All providers in Plymouth, MA · Community Based Hospice Care Agency in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 23, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.