Superior Hospice Inc.

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

SUPERIOR HOSPICE INC.

Practice address

800 Boone Ave N Ste 194
Golden Valley, MN 55427-4476

Phone

(763) 277-8777

Fax

(763) 277-8778

NPI assigned

Sep 28, 2023

Last updated

Nov 22, 2024By 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

Michael Lecy

Title

VP of Operations

Phone

(763) 233-7565

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265211171. Details of each certification follow.

• CCN 241625 Hospice · Active · Details

Hospice certification: CCN 241625

Legal name

SUPERIOR HOSPICE INC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Oct 21, 2024

Last certification

Oct 10, 2024

Organization structure

CorporationProprietary

Incorporated

Sep 10, 2023 in MN

Enrollment address

800 Boone Ave N
Ste 194
Golden Valley, MN 55427-4476

Listed as

Superior Hospice Inc.CCN 241625 · All quality measures

Certified

Oct 21, 2024

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 6

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.

• Assen Nikolaev Chekerdjiev, M.D.

  • Internal Medicine Physician
  • Shakopee, MN
  • NPI 1417919267

  W-2 Managing Employee

  CMS ownership

Affiliated clinicians 3

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

• Assen Nikolaev Chekerdjiev, M.D.

  • Internal Medicine Physician
  • Shakopee, MN
  • NPI 1417919267

  Hospice

  Care Compare affiliation
• Larissa M Dimitrov, MD

  • Family Medicine Physician
  • Shoreview, MN
  • NPI 1386827053

  Hospice

  Care Compare affiliation
• Brian Lewis, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Golden Valley, MN
  • NPI 1235525015

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1695859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732233600000",
    "number": "1265211171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 BOONE AVE N",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554274468",
            "telephone_number": "763-267-6648",
            "fax_number": "763-417-9999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 BOONE AVE N STE 194",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554274476",
            "telephone_number": "763-277-8777",
            "fax_number": "763-277-8778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERIOR HOSPICE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-28",
        "last_updated": "2024-11-22",
        "certification_date": "2024-11-22",
        "status": "A",
        "authorized_official_last_name": "LECY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "763-233-7565"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nancy Strong, RN, AGNP
• Gary Edward Stucky, MA/LP
• Jessica Lauren Stulc, MD
• Sienneh Subah
• Summit Home Health Care, Inc.
• Supreme Home Care Provider, LLC
• Christa Ruth Surerus, LPCC
• Lisa Sutton, PHARMD
• Amy Svenningsen
• Erica Lynn Swanson, MOT, OTR/L

• Community Based Hospice Care Agency in Golden Valley, MN
• Providers in Golden Valley, MN by specialty
• Community Based Hospice Care Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 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.