NPIMap

Organization Active NPI

Hospice of Northwest Ohio

  • Community Based Hospice Care Agency
  • Perrysburg, OH
National Provider Identifier
1265435499
Registry record updated Jan 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
0100HSP Issued in OH
Legal business name
HOSPICE OF NORTHWEST OHIO
Practice address
30000 E River Rd
Perrysburg, OH 43551-3429
Phone
(419) 661-4001
Fax
(419) 661-4015
NPI assigned
May 23, 2005
Last updated
Jan 15, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2024

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

Authorized official

Name
Richard Earl Russell
Title
President and Ceo
Phone
(419) 931-5109

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 0100HSP OH Primary

Addresses

Primary practice location

30000 E River Rd
Perrysburg, OH 43551-3429

Mailing address

30000 E River Rd
Perrysburg, OH 43551-3429
Phone (419) 661-4001

Other identifiers 2

IdentifierTypeStateIssuer
1617035MedicaidMI
0820099MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, MI3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20070817000186 OH Part B Supplier - Clinic/Group Practice 8527150721 Receives reassigned benefits from 36 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Perrysburg, OH
O20080328000250 OH Part A Provider - Hospice 8527150721 Practice locations: Lambertville, MI; Perrysburg, OH; Sylvania, OH; Toledo, OH; Wauseon, OH
O20100108000415 MI Part A Provider - Hospice 8527150721 Practice locations: Lambertville, MI

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1265435499. Details of each certification follow.

Hospice certification: CCN 361502

Legal name
HOSPICE OF NORTHWEST OHIO
Certification status
Active
Provider type (POS)
Hospice
Participating since
Mar 19, 1984
Last certification
Feb 6, 2004
Ownership / control type
Non-Profit - Private
Organization structure
CorporationNon-profit
Incorporated
Jan 29, 1979 in OH
Enrollment address
30000 E River Rd
Perrysburg, OH 43551-3429

Hospice certification: CCN 231618

Legal name
HOSPICE OF NORTHWEST OHIO
Certification status
Active
Provider type (POS)
Hospice
Participating since
Apr 28, 2010
Last certification
Apr 28, 2010
Ownership / control type
Non-Profit - Private
Organization structure
CorporationNon-profit
Incorporated
Jan 29, 1979 in OH
Enrollment address
8132 Secor Road
Lambertville, MI 48144-8673

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospice

Medicare Care Compare
Listed as
Hospice of Northwest OhioCCN 231618 · All quality measures
Ownership
Non-Profit
Certified
Apr 28, 2010
Medicare certification status
ActiveFrom the Provider of Services file

Care Compare: Hospice

Medicare Care Compare
Listed as
Hospice of Northwest OhioCCN 361502 · All quality measures
Ownership
Non-Profit
Certified
Mar 19, 1984
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D1102236Hospice of Northwest Ohio8132 Secor Road, Lambertville, MI 48144Certificate of waiverJul 13, 2027

National Provider Directory

National Provider Directory

Locations

30000 E River Rd
Perrysburg, OH 43551
Phone (419) 661-4001

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
William Jenks Individual Corporate DirectorBoard of Trustee Nov 26, 2018
Corporate DirectorBoard of Trustees Nov 26, 2018
Anthony R Clark Individual Corporate OfficerChair, Board of Trustees May 18, 2015
Corporate DirectorBoard of Trustees May 18, 2015
Richard E Russell Individual Corporate OfficerPresident and Ceo Apr 1, 2021
W-2 Managing EmployeeAd; Apr 1, 2021
Operational/Managerial ControlPresident & Ceo Apr 1, 2021
Corporate OfficerPresident and Ceo Apr 1, 2021 100%
W-2 Managing EmployeePresident and Ceo Apr 1, 2021 100%
Operational/Managerial Control Apr 1, 2021 100%
Gary Lynn Byers Individual Corporate DirectorBoard of Trustees May 23, 2016
Corporate Director May 23, 2016
Barbara Eikost Individual Corporate OfficerSecretary, Board of Trustees May 23, 2016
Corporate DirectorBoard of Trustees May 23, 2016
Marylouise S Bowe Individual Corporate DirectorBoard of Trustee May 19, 2018
Corporate DirectorBoard of Trustees May 21, 2018
Cynthia L Rerucha Individual Corporate OfficerVice Chair, Board of Trustees May 21, 2018
Corporate DirectorBoard of Trustees May 21, 2018
Marsha S Paul Individual W-2 Managing EmployeeMD; Jul 1, 2001
Kay W Rasmus Individual Corporate DirectorBoard of Trustees May 18, 2015
Lorrie Ann Elchert Individual Corporate DirectorBoard of Trustee Jun 17, 2018
Corporate Director May 21, 2018
Kenneth Krupp Individual Corporate DirectorTrustee May 20, 2019
Diana G French Individual Corporate DirectorBoard of Trustees May 23, 2016
Tom Myers Individual Operational/Managerial ControlCfo & VP of Operations Jul 10, 2023
Linda J Hillstrom Individual Corporate DirectorBoard of Trustees May 18, 2015
William Hylan Individual Corporate OfficerTreasurer, Board of Trustees May 20, 2019
Corporate DirectorTrustee May 20, 2019
Ann M Baker Individual Corporate DirectorBoard of Trustees May 20, 2013
Rebecca Gorman Individual Corporate DirectorBoard of Trustees May 21, 2012
Susan E Morgan Individual Corporate DirectorBoard of Trustees May 19, 2014
David G Schlaudecker Individual Corporate DirectorBoard of Trustees May 20, 2013
Carmela G Barone Individual Corporate DirectorBoard of Trustees May 23, 2016
Bradley L Blandin Individual Corporate Director May 21, 2018

Owners & managing parties with NPI records 2

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

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.

Practitioners & affiliated clinicians

Practitioners 45

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.

View all 45

Affiliated clinicians 34

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

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705276800000",
    "number": "1265435499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30000 E RIVER RD",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435513429",
            "telephone_number": "419-661-4001",
            "fax_number": "419-661-4015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30000 E RIVER RD",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435513429",
            "telephone_number": "419-661-4001",
            "fax_number": "419-661-4015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPICE OF NORTHWEST OHIO",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-23",
        "last_updated": "2024-01-15",
        "certification_date": "2024-01-15",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "EARL",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "419-931-5109"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "OH",
            "license": "0100HSP",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1617035",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0820099",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Perrysburg, OH

Sources for this page

Verify at the official NPI Registry.