Active NPI
Moments Hospice of Green Bay LLC
- Community Based Hospice Care Agency
- Green Bay, WI
National Provider Identifier
1245971167
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- Legal business name
- MOMENTS HOSPICE OF GREEN BAY LLC
- Practice address
- 2140 Velp Ave
Green Bay, WI 54303-6492 - Phone
- (877) 666-3687
- Fax
- (763) 205-9350
- NPI assigned
- Apr 5, 2022
- Last updated
- Sep 21, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Eliyahu Jaffa
- Title
- President
- Phone
- (715) 800-0908
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Primary |
Addresses
Primary practice location
2140 Velp Ave
Green Bay, WI 54303-6492
Mailing address
2140 Velp Ave
Green Bay, WI 54303-6492
Phone (877) 666-3687
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20221101001171 | WI | Part A Provider - Hospice | 1850768060 | Practice locations: Green Bay, WI |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1245971167. Details of each certification follow.
Hospice certification: CCN 521619
- Legal name
- MOMENTS HOSPICE OF GREEN BAY LLC
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Nov 29, 2022
- Last certification
- Nov 23, 2022
- Organization structure
- LLC
- Incorporated
- Jan 26, 2022 in WI
- Enrollment address
- 2140 Velp Ave
Green Bay, WI 54303
Care Compare: Hospice
Medicare Care Compare- Listed as
- Moments Hospice of Green Bay
- Certified
- Nov 29, 2022
- Medicare certification status
- Active
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 4
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 |
|---|---|---|---|
| Shlomo Miller | 5% Or Greater Direct Ownership Interest | Jan 26, 2021 | 50% |
| Operational/Managerial Control | Aug 1, 2022 | 51% | |
| Eliyahu Jaffa | 5% Or Greater Direct Ownership Interest | Jan 26, 2021 | 50% |
| Joseph Greenberg | Contracted Managing Employee | Jul 1, 2024 | |
| Katie Jean Wasielewski | W-2 Managing Employee | Apr 1, 2026 |
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
- St Louis Park, MN
- NPI 1114169356
Contracted Managing Employee
Practitioners & affiliated clinicians
Affiliated clinicians 24
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": "1649116800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1695254400000",
"number": "1245971167",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2140 VELP AVE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543036492",
"telephone_number": "877-666-3687",
"fax_number": "763-205-9350"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2140 VELP AVE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543036492",
"telephone_number": "877-666-3687",
"fax_number": "763-205-9350"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MOMENTS HOSPICE OF GREEN BAY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2022-04-05",
"last_updated": "2023-09-21",
"certification_date": "2023-09-21",
"status": "A",
"authorized_official_last_name": "JAFFA",
"authorized_official_first_name": "ELIYAHU",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "715-800-0908"
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; 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.