NPIMap

Organization Active NPI

Heartland Hospice Services, LLC

Doing business as ProMedica Hospice (Charleston)

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • North Charleston, SC
National Provider Identifier
1174268965
Registry record updated May 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Internal Medicine) PhysicianTaxonomy code 207RH0002X
Legal business name
HEARTLAND HOSPICE SERVICES, LLC
Doing business as
ProMedica Hospice (Charleston)
Practice address
7410 Northside Dr Ste 250
North Charleston, SC 29420-4292
Phone
(843) 766-7646
NPI assigned
May 5, 2022
Last updated
May 5, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2022

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

Authorized official

Name
Martin David Allen
Title
Sole Director
Phone
(419) 252-5734

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X Primary

Addresses

Primary practice location

7410 Northside Dr Ste 250
North Charleston, SC 29420-4292

Mailing address

PO Box 10086
Toledo, OH 43699-0086

Other identifiers 1

IdentifierTypeStateIssuer
HSP052MedicaidSC

Other names 1

  • ProMedica Hospice (Charleston) Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200619000235 SC Part B Supplier - Clinic/Group Practice 4789592536 Receives reassigned benefits from 7 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Charleston, SC; Myrtle Beach, SC; Simpsonville, SC

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Tax ID family
Heartland Hospice SVCS LLC33 organizations share this tax ID, including this one

Other organizations with this tax ID 32

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

View all 32

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Terrence G Metzger Individual Corporate OfficerTreasurer Nov 1, 2023
Martin D Allen Individual Corporate DirectorSole Director Sep 30, 2012
Operational/Managerial ControlChain Home Office Administrator Sep 22, 2007
HCR Manor Care Services LLC Organization, Toledo, OH Operational/Managerial Control Dec 21, 2007
HCR Healthcare, LLC Organization, Toledo, OH Non-profit 5% Or Greater Indirect Ownership Interest Dec 21, 2007 100%
Dean Shipman Individual W-2 Managing EmployeeAvp Reimbursement Services May 1, 2016
Kylie Montoya Individual Contracted Managing EmployeeAdministrator Dec 15, 2014
Kathryn H Hoops Individual Corporate OfficerVP Nov 7, 2007
Stephen M Sadowski Individual Corporate OfficerSecretary Nov 1, 2023
Justin Skiver Individual Corporate OfficerPresident Aug 29, 2023
Andrea Sype Individual Corporate OfficerVice President Jan 1, 2021
HCR Manorcare, Inc. Organization, Toledo, OH Non-profit 5% Or Greater Indirect Ownership Interest Jul 26, 2018 100%
HCR Home Health Care and Hospice LLC Organization, Toledo, OH Non-profit 5% Or Greater Direct Ownership Interest Dec 21, 2007 100%
Eric J Talbert Individual Corporate OfficerAssistant Vice President Jun 24, 2013
Promedica Health System Inc Organization, Toledo, OH Non-profit 5% Or Greater Indirect Ownership Interest Jul 26, 2018 100%

NPI Registry JSON

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

{
    "created_epoch": "1651708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651708800000",
    "number": "1174268965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10086",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436990086"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7410 NORTHSIDE DR STE 250",
            "city": "NORTH CHARLESTON",
            "state": "SC",
            "postal_code": "294204292",
            "telephone_number": "843-766-7646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEARTLAND HOSPICE SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-05",
        "last_updated": "2022-05-05",
        "certification_date": "2022-04-19",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "SOLE DIRECTOR",
        "authorized_official_telephone_number": "419-252-5734"
    },
    "taxonomies": [
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "HSP052",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProMedica Hospice (Charleston)",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in North Charleston, SC

Sources for this page

Verify at the official NPI Registry.