Superior Hospice of Northwest Louisiana, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

238 Issued in LA

Legal business name

SUPERIOR HOSPICE OF NORTHWEST LOUISIANA, LLC

Practice address

511 Jenkins St.
Suite B
Mansfield, LA 71052

Phone

(318) 872-2000

Fax

(318) 872-2001

NPI assigned

Jul 26, 2007

Last updated

May 14, 2012By 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

Charles G Gladney Jr.

Title

Managing Partner

Phone

(318) 281-0078

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in LA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255521183. Details of each certification follow.

• CCN 191664 Hospice · Active · Details

Hospice certification: CCN 191664

Legal name

SUPERIOR HOSPICE OF NORTHWEST LOUISIANA, LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Oct 1, 2008

Last certification

May 28, 2020

Ownership / control type

Proprietary - Other

Organization structure

LLCProprietary

Enrollment address

511 Jenkins St
Ste B
Mansfield, LA 71052-3705

Listed as

Superior HospiceCCN 191664 · All quality measures

Ownership

For-Profit

Certified

Oct 1, 2008

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 11

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 4

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

• Denis Kamberov, MD

  • Internal Medicine Physician
  • Mansfield, LA
  • NPI 1932188422

  5% Or Greater Direct Ownership Interest

  CMS ownership
• Robert J Massingill, MD

  • Hematology & Oncology Physician
  • Bossier City, LA
  • NPI 1770587461

  5% Or Greater Direct Ownership Interest, W-2 Managing Employee

  CMS ownership
• Douglas Clayton Sawyer, MD

  • General Practice Physician
  • Mansfield, LA
  • NPI 1376577304

  5% Or Greater Direct Ownership Interest

  CMS ownership
• Christopher S. Snead, MD

  • Hematology & Oncology Physician
  • Coushatta, LA
  • NPI 1780673665

  5% Or Greater Direct Ownership Interest

  CMS ownership

Practitioners 2

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.

• Denis Kamberov, MD

  • Internal Medicine Physician
  • Mansfield, LA
  • NPI 1932188422
  NPD (past)
• CHI Tai Peter Lau, M.D.

  • Family Medicine Physician
  • Zwolle, LA
  • NPI 1750340592
  NPD (past)

Affiliated clinicians 3

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

• Denis Kamberov, MD

  • Internal Medicine Physician
  • Mansfield, LA
  • NPI 1932188422

  Hospice

  Care Compare affiliation
• Benjamin Leggio, MD

  • Family Medicine Physician
  • Mansfield, LA
  • NPI 1851370332

  Hospice

  Care Compare affiliation
• Cody Tingle, M.D.

  • Internal Medicine Physician
  • Shreveport, LA
  • NPI 1699031237

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1185408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336953600000",
    "number": "1255521183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1523 TEXAS AVE.",
            "city": "BASTROP",
            "state": "LA",
            "postal_code": "712204043",
            "telephone_number": "318-281-0078",
            "fax_number": "318-281-2753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 JENKINS ST.",
            "address_2": "SUITE B",
            "city": "MANSFIELD",
            "state": "LA",
            "postal_code": "71052",
            "telephone_number": "318-872-2000",
            "fax_number": "318-872-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERIOR HOSPICE OF NORTHWEST LOUISIANA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-26",
        "last_updated": "2012-05-14",
        "status": "A",
        "authorized_official_last_name": "GLADNEY",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "318-281-0078",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "LA",
            "license": "TBD",
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "LA",
            "license": "238",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1381179",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOINT COMMISSION HCO ID",
            "identifier": "468572",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community Based Hospice Care Agency in Mansfield, LA
• Providers in Mansfield, LA by specialty
• Community Based Hospice Care Agency in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2012; 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.