NPIMap

Organization Active NPI

Lily Hospice LLC

  • Community Based Hospice Care Agency
  • Brookfield, WI
National Provider Identifier
1235870478
Registry record updated Dec 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
LILY HOSPICE LLC
Practice address
15430 W Capitol Dr Ste 100
Brookfield, WI 53005-2626
Phone
(262) 235-3115
Fax
(262) 537-5140
NPI assigned
Apr 3, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2024

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

Authorized official

Name
Keith Rasimus
Title
Ceo
Phone
(262) 235-3115

Specialties & licenses 1

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

Addresses

Primary practice location

15430 W Capitol Dr Ste 100
Brookfield, WI 53005-2626

Mailing address

15430 W Capitol Dr Ste 100
Brookfield, WI 53005-2626
Phone (262) 235-3115

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221108001466 WI Part A Provider - Hospice 7719354596 Practice locations: Brookfield, WI

Hospice certification: CCN 521615

Legal name
LILY HOSPICE LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Dec 28, 2022
Last certification
Dec 8, 2022
Organization structure
LLCProprietary
Incorporated
Feb 1, 2022 in WI
Enrollment address
15430 W Capitol Dr
Ste 100
Brookfield, WI 53005-2626

Care Compare: Hospice

Medicare Care Compare
Listed as
Lily HospiceCCN 521615
Certified
Dec 28, 2022
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Lily Hospice LLC2 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.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

W63N545 Hanover Ave
Cedarburg, WI 53012
Phone (262) 421-5133

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Tracy Merle Geiger Individual 5% Or Greater Direct Ownership InterestPresident Feb 1, 2022 100%
Operational/Managerial ControlAdministrator Feb 1, 2022 90%
Kelly J Darmody Individual Contracted Managing EmployeeMD; Jul 15, 2022 10%

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Lily Home and HospiceEau Claire, WI, CCN 521621 Hospice 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jun 25, 2023
Jun 25, 2023

Owned or controlled facilities with NPI records 1

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

  • Lily Home and Hospice
    • Community Based Hospice Care Agency
    • Eau Claire, WI
    • NPI 1700564937

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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": "1648944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1733875200000",
    "number": "1235870478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15430 W CAPITOL DR STE 100",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530052626",
            "telephone_number": "262-235-3115",
            "fax_number": "262-537-5140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15430 W CAPITOL DR STE 100",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530052626",
            "telephone_number": "262-235-3115",
            "fax_number": "262-537-5140"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LILY HOSPICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-03",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A",
        "authorized_official_last_name": "RASIMUS",
        "authorized_official_first_name": "KEITH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "262-235-3115"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookfield, WI

Sources for this page

Verify at the official NPI Registry.