Prodigious Hospices LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

PRODIGIOUS HOSPICES LLC

Practice address

9000 Tesoro Dr Ste 200
San Antonio, TX 78217-6132

Phone

(210) 946-1367

Fax

(210) 756-3003

NPI assigned

May 27, 2022

Organization subpart

No

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

Authorized official

Name

Geoff ColacinoNPI 1710518907

Title

Administrator

Phone

(210) 946-1367

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Hospice certification: CCN A91573

Legal name

PRODIGIOUS HOSPICES LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Dec 19, 2022

Last certification

Dec 1, 2022

Ownership / control type

Proprietary - Other

Organization structure

LLCProprietary

Incorporated

Jul 14, 2020 in TX

Enrollment address

9000 Tesoro Dr
Ste 200
San Antonio, TX 78217-6132

Listed as

Prodigious Hospices LLCCCN A91573

Certified

Dec 19, 2022

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 3

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

Owners & managing parties with NPI records 1

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

• Angelica Esquivel Davila, M.D.

  • Geriatric Medicine (Family Medicine) Physician
  • San Antonio, TX
  • NPI 1366703720

  Contracted Managing Employee

  CMS ownership

Practitioners 2

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

• Geoff Colacino, RN

  • Hospice Registered Nurse
  • San Antonio, TX
  • NPI 1710518907
  NPD Authorized official
• Angelica Esquivel Davila, M.D.

  • Geriatric Medicine (Family Medicine) Physician
  • San Antonio, TX
  • NPI 1366703720
  NPD (past)

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Angelica Esquivel Davila, M.D.

  • Geriatric Medicine (Family Medicine) Physician
  • San Antonio, TX
  • NPI 1366703720

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1653609600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730246400000",
    "number": "1245978378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 TESORO DR STE 200",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782176132",
            "telephone_number": "210-946-1367",
            "fax_number": "210-756-3003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 TESORO DR STE 200",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782176132",
            "telephone_number": "210-946-1367",
            "fax_number": "210-756-3003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRODIGIOUS HOSPICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-27",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A",
        "authorized_official_last_name": "COLACINO",
        "authorized_official_first_name": "GEOFF",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "210-946-1367"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; 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.

Verify at the official NPI Registry.