Active NPI
Bristol Hospice - Sacramento, LLC
- Community Based Hospice Care Agency
- Roseville, CA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- Legal business name
- BRISTOL HOSPICE - SACRAMENTO, LLC
- Practice address
- 2140 Professional Dr
Suite 210
Roseville, CA 95661 - Phone
- (916) 782-5511
- Fax
- (916) 782-5635
- NPI assigned
- Jun 5, 2007
- Last updated
- May 18, 2018
- Organization subpart
- Yes
- Parent organization
- BRISTOL HOSPICE, L.L.C.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Hyrum Kirton
- Title
- President/Ceo
- Phone
- (801) 325-0175
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Primary |
Addresses
Primary practice location
2140 Professional Dr
Suite 210
Roseville, CA 95661
Mailing address
206 N 2100 W Ste 200
Salt Lake City, UT 84116-4741
Phone (801) 325-0137
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070705000262 | CA | Part A Provider - Hospice | 8123128154 | Practice locations: Roseville, CA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1235331828. Details of each certification follow.
Hospice certification: CCN 551538
- Legal name
- BRISTOL HOSPICE - SACRAMENTO LLC
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Feb 3, 2009
- Last certification
- Dec 15, 2021
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- LLC
- Incorporated
- May 25, 2017 in UT
- Enrollment address
- 2140 Professional Dr
Ste 210
Roseville, CA 95661-3776
Care Compare: Hospice
Medicare Care Compare- Listed as
- Bristol Hospice - Sacramento, LLC
- Ownership
- For-Profit
- Certified
- Feb 3, 2009
- Medicare certification status
- Active
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D1077480 | Bristol Hospice - Sacramento, LLC | Certificate of waiver | Dec 10, 2027 |
National Provider Directory
National Provider Directory- Part of
- Bristol Hospice LLC
Locations
2140 Professional Dr
Ste 150
Roseville, CA 95661
Phone (916) 782-5511
Ownership & related parties
All disclosed owners & managing parties 13
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| David E Massil | Contracted Managing Employee | Mar 1, 2022 | |
| Bristol Hospice Holdings Inc | 5% Or Greater Indirect Ownership Interest | Dec 1, 2017 | 100% |
| Alex Edward Mauricio | Corporate Officer | Jan 1, 2023 | |
| Corporate Director | Jan 1, 2023 | ||
| Webster Equity Partners Bristol CF LP | 5% Or Greater Indirect Ownership Interest | Sep 1, 2023 | 69.8% |
| John Charles Garbarino | Corporate Officer | Jul 18, 2017 | |
| Corporate Director | Jul 18, 2017 | ||
| Webster Equity Partners IV Bristol CF LP | 5% Or Greater Indirect Ownership Interest | Sep 1, 2023 | 5.72% |
| Michael Derrick | Corporate Officer | Sep 1, 2023 | |
| Bristol Ultimate Holdco, LP | 5% Or Greater Indirect Ownership Interest | Sep 1, 2023 | 100% |
| Aware Super Pty, LTD. | 5% Or Greater Indirect Ownership Interest | Jan 24, 2022 | 8.28% |
| Bristol Hospice, L.L.C. | 5% Or Greater Direct Ownership Interest | Jul 2, 2007 | 100% |
| Michael Stanton | W-2 Managing Employee | Jan 1, 2023 | |
| Bristol Hospice Topco Inc | 5% Or Greater Indirect Ownership Interest | Dec 1, 2017 | 100% |
| David a Malm | Corporate Officer | Jul 18, 2017 | |
| Corporate Director | Jul 18, 2017 | 100% |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- Roseville, CA
- NPI 1528246840
Contracted Managing Employee
Facilities with the same owner 52
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
- Community Based Hospice Care Agency
- Merced, CA
- NPI 1487603452
Aware Super Pty, LTD., Bristol Hospice Holdings Inc, Bristol Hospice Topco Inc, Bristol Hospice, L.L.C., Bristol Ultimate Holdco, LP, Webster Equity Partners Bristol CF LP, Webster Equity Partners IV Bristol CF LP
-
dba Bristol Hospice - Inland Empire
- Community Based Hospice Care Agency
- Riverside, CA
- NPI 1043683170
Aware Super Pty, LTD., Bristol Hospice Holdings Inc, Bristol Hospice Topco Inc, Bristol Hospice, L.L.C., Bristol Ultimate Holdco, LP, Webster Equity Partners Bristol CF LP, Webster Equity Partners IV Bristol CF LP
-
dba All Saints Hospice, Inc.
- Community Based Hospice Care Agency
- Ontario, CA
- NPI 1013318112
Aware Super Pty, LTD., Bristol Hospice Holdings Inc, Bristol Hospice Topco Inc, Bristol Hospice, L.L.C., Bristol Ultimate Holdco, LP, Webster Equity Partners Bristol CF LP, Webster Equity Partners IV Bristol CF LP
-
dba Bristol Hospice
- Community Based Hospice Care Agency
- Glendale, CA
- NPI 1043449291
Aware Super Pty, LTD., Bristol Hospice Holdings Inc, Bristol Hospice Topco Inc, Bristol Hospice, L.L.C., Bristol Ultimate Holdco, LP, Webster Equity Partners Bristol CF LP, Webster Equity Partners IV Bristol CF LP
-
dba Bristol Hospice - Greater Los Angeles
- Community Based Hospice Care Agency
- Lakewood, CA
- NPI 1548217011
Aware Super Pty, LTD., Bristol Hospice Holdings Inc, Bristol Hospice Topco Inc, Bristol Hospice, L.L.C., Bristol Ultimate Holdco, LP, Webster Equity Partners Bristol CF LP, Webster Equity Partners IV Bristol CF LP
-
dba Bristol Hospice - Orange County
- Community Based Hospice Care Agency
- Costa Mesa, CA
- NPI 1497758593
Aware Super Pty, LTD., Bristol Hospice Holdings Inc, Bristol Hospice Topco Inc, Bristol Hospice, L.L.C., Bristol Ultimate Holdco, LP, Webster Equity Partners Bristol CF LP, Webster Equity Partners IV Bristol CF LP
-
dba Bristol Hospice - Fresno
- Community Based Hospice Care Agency
- Fresno, CA
- NPI 1164590089
Aware Super Pty, LTD., Bristol Hospice Holdings Inc, Bristol Hospice Topco Inc, Bristol Hospice, L.L.C., Bristol Ultimate Holdco, LP, Webster Equity Partners Bristol CF LP, Webster Equity Partners IV Bristol CF LP
-
dba Bristol Hospice - Bakersfield
- Community Based Hospice Care Agency
- Bakersfield, CA
- NPI 1396726493
Aware Super Pty, LTD., Bristol Hospice Holdings Inc, Bristol Hospice Topco Inc, Bristol Hospice, L.L.C., Bristol Ultimate Holdco, LP, Webster Equity Partners Bristol CF LP, Webster Equity Partners IV Bristol CF LP
-
dba Bristol Hospice - Lancaster
- Community Based Hospice Care Agency
- Lancaster, CA
- NPI 1689181323
Aware Super Pty, LTD., Bristol Hospice Holdings Inc, Bristol Hospice Topco Inc, Bristol Hospice, L.L.C., Bristol Ultimate Holdco, LP, Webster Equity Partners Bristol CF LP, Webster Equity Partners IV Bristol CF LP
-
dba Bristol Hospice - Stockton
- Community Based Hospice Care Agency
- Stockton, CA
- NPI 1821166745
Aware Super Pty, LTD., Bristol Hospice Holdings Inc, Bristol Hospice Topco Inc, Bristol Hospice, L.L.C., Bristol Ultimate Holdco, LP, Webster Equity Partners Bristol CF LP, Webster Equity Partners IV Bristol CF LP
-
dba Bristol Hospice-Redding
- Community Based Hospice Care Agency
- Redding, CA
- NPI 1972918753
Aware Super Pty, LTD., Bristol Hospice Holdings Inc, Bristol Hospice Topco Inc, Bristol Hospice, L.L.C., Bristol Ultimate Holdco, LP, Webster Equity Partners Bristol CF LP, Webster Equity Partners IV Bristol CF LP
-
dba Bristol Hospice - San Diego
- Community Based Hospice Care Agency
- San Diego, CA
- NPI 1659781045
Aware Super Pty, LTD., Bristol Hospice Holdings Inc, Bristol Hospice Topco Inc, Bristol Hospice, L.L.C., Bristol Ultimate Holdco, LP, Webster Equity Partners Bristol CF LP, Webster Equity Partners IV Bristol CF LP
Practitioners & affiliated clinicians
Affiliated clinicians 10
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181001600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1526601600000",
"number": "1235331828",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "206 N 2100 W STE 200",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "841164741",
"telephone_number": "801-325-0137",
"fax_number": "801-478-3529"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2140 PROFESSIONAL DR",
"address_2": "SUITE 210",
"city": "ROSEVILLE",
"state": "CA",
"postal_code": "95661",
"telephone_number": "916-782-5511",
"fax_number": "916-782-5635"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BRISTOL HOSPICE - SACRAMENTO, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "BRISTOL HOSPICE, L.L.C.",
"enumeration_date": "2007-06-05",
"last_updated": "2018-05-18",
"status": "A",
"authorized_official_last_name": "KIRTON",
"authorized_official_first_name": "HYRUM",
"authorized_official_title_or_position": "PRESIDENT/CEO",
"authorized_official_telephone_number": "801-325-0175"
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roseville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2018; 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.