Encore Hospice LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

ENCORE HOSPICE LLC

Practice address

4122 W Innovation Dr
Ste H and I
Phoenix, AZ 85086

Phone

(623) 695-0813

NPI assigned

Dec 15, 2022

Last updated

Dec 15, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Holly Decker Carlson, RN

Title

Administrator

Phone

(623) 695-0813

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255043816. Details of each certification follow.

• CCN 001568 Hospice · Active · Details

Hospice certification: CCN 001568

Legal name

ENCORE HOSPICE LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Aug 15, 2023

Last certification

Jul 28, 2023

Organization structure

LLCProprietary

Enrollment address

4122 W Innovative Dr
Ste 101H&I
Phoenix, AZ 85086-3846

Listed as

Encore Hospice LLCCCN 001568 · All quality measures

Certified

Aug 15, 2023

Medicare certification status

ActiveFrom the Provider of Services file

Tax ID family

Encore 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.

• Encore Hospice LLC

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Phoenix, AZ
  • NPI 1912861725
  NPD tax ID

Locations

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.

Owners & managing parties with NPI records 1

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

• Ryan T Wood, D.O.

  • Internal Medicine Physician
  • Anthem, AZ
  • NPI 1558358994

  W-2 Managing Employee

  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.

• Encore Hospice LLC

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Phoenix, AZ
  • NPI 1912861725
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sam Ile

  • Assisted Living Facility (Behavioral Disturbances)
  • Anthem, AZ
  • NPI 1326508953
  NPD

Affiliated clinicians 1

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

• Ryan T Wood, D.O.

  • Internal Medicine Physician
  • Anthem, AZ
  • NPI 1558358994

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1671062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671062400000",
    "number": "1255043816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3655 W ANTHEM WAY STE. A109-386",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85086",
            "telephone_number": "623-695-0813"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4122 W INNOVATION DR",
            "address_2": "STE H AND I",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85086",
            "telephone_number": "623-695-0813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENCORE HOSPICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-15",
        "last_updated": "2022-12-15",
        "certification_date": "2022-12-14",
        "status": "A",
        "authorized_official_last_name": "DECKER CARLSON",
        "authorized_official_first_name": "HOLLY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "623-695-0813",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Vicente Enciso, MD
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• Elane Endecott, PHARMD
• Spencer James Endecott

• Community Based Hospice Care Agency in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Community Based Hospice Care Agency in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2022; 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.