Crossroads Hospice of Cincinnati
Organization Active NPI Community Based Hospice Care Agency · Cincinnati, OH
NPI 1285673111 · NPPES record last updated Nov 14, 2022
Key facts
- NPI
- 1285673111
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- License
- 0136HSP (OH)
- Legal business name
- CROSSROADS HOSPICE OF CINCINNATI
- Practice address
- 4380 Glendale Milford Rd
Cincinnati, OH 45242-3706 - Phone
- (513) 793-5070
- Fax
- (513) 793-5110
- NPI assigned
- Jun 6, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- CARREFOUR ASSOCIATES, LLC
Authorized official
- Name
- Mr. Clayton Lee Farmer
- Title
- Cfo/Coo
- Phone
- (918) 627-6846
Corporate family (same tax ID) 1
Facilities with the same owner 5
Practitioners 10
-
Sharrise Evans, FNP-C
-
Rajan S Lakhia, DO
-
Anjana Benjamin Lyons, APRN CNP
-
Tamara White, NP
-
Megan Lee Miller, NP
Affiliated clinicians 9
-
Saba Azher Ansari, M.D
-
Rafael Fleites, M.D.
-
Jason P. Graff, MD
-
Husam Hamed, M.D.
-
Milla Karev, MD
-
Rajan S Lakhia, DO
-
Jyoti J Mehta, MD
Medicare Care Compare: Hospice
- Listed as
- Crossroads Hospice of Cincinnati, LLC
- Ownership
- For-Profit
- Certified
- Aug 21, 2003
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OH
Hospice certification: CCN 361614
- Legal name
- CROSSROADS HOSPICE OF CINCINNATI
- Doing business as
- CROSSROADS HOSPICE OF CINCINNATI, LLC
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Aug 21, 2003
- Last certification
- Sep 30, 2021
- Ownership / control type
- Proprietary - Other
- Organization structure
- LLC · Proprietary
- Enrollment address
- 4380 Gelndale Milford Rd
Cincinnati, OH 45242-3706
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Perry&Jessica Farmer Investments FLP |
5% Or Greater Direct Ownership Interest | Jan 1, 2006 | 19% |
| George Farmer Rvoc TR |
5% Or Greater Direct Ownership Interest | Nov 10, 2022 | |
| George Perry Farmer |
5% Or Greater Direct Ownership Interest | Nov 27, 2002 | |
| General Partnership Interest | Nov 27, 2002 | ||
| Corporate Director | Apr 29, 2003 | ||
| Deanna Looper |
W-2 Managing Employee | Jan 1, 2003 | |
| Carrefour Associates, LLC |
Operational/Managerial Control | Dec 1, 2002 | |
| Jamie Tower |
5% Or Greater Direct Ownership Interest | Nov 27, 2002 | |
| General Partnership Interest | Nov 27, 2002 | ||
| Clayton Lee Farmer |
5% Or Greater Direct Ownership Interest | Nov 27, 2002 | |
| General Partnership Interest | Nov 27, 2002 | ||
| Corporate Director | Apr 29, 2003 | ||
| Read & Melissa Pearson Family Trust |
5% Or Greater Direct Ownership Interest | Jan 1, 2022 | 5% |
| Sherrie Whitson |
W-2 Managing Employee |
Nov 1, 2022 | |
| Debra Whitesell |
W-2 Managing Employee |
Sep 3, 2024 | |
| Laura Buxton |
W-2 Managing Employee |
Jan 1, 2006 | |
| Raymond Freeman |
5% Or Greater Direct Ownership Interest | Nov 27, 2002 | |
| General Partnership Interest | Nov 27, 2002 | ||
| Corporate Director | Apr 29, 2003 | ||
| Car Holdings LLC |
5% Or Greater Direct Ownership Interest | Jan 1, 2006 | 19% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030429000016 | OH | Part a Provider - Hospice | 9133039936 | Practice locations: Cincinnati, OH |
| O20140207001127 | OH | Part B Supplier - Clinic/Group Practice | 9133039936 |
Receives reassigned benefits from 9 practitioners Practice locations: Blue Ash, OH |
National Provider Directory
- Tax ID family
- Crossroads Hospice and Palliative Care
Locations
4380 Glendale Milford Rd
Blue Ash, OH 45242
Phone (513) 793-5070
9912 Carver Rd
Ste 101
Blue Ash, OH 45242
Phone (513) 793-5070
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospice and Palliative Medicine (Family Medicine) Physician |
207QH0002X | |||
| Community Based Hospice Care Agency | 251G00000X | 0136HSP | OH | Yes |
Addresses
Primary practice location
4380 Glendale Milford Rd
Cincinnati, OH 45242-3706
Mailing address
10810 E 45TH St
Suite 300
Tulsa, OK 74146-3818
Phone (918) 627-6846
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2422659 | Medicaid | OH |
Other names
- Crossroads Hospice of Cincinnati, LLC
- Crossroads Hospice and Palliative Care
Other providers in Cincinnati, OH
- Eva Breanne Cross
- Kelsea Cross
- Kortnee Cross
- Lauren A Cross
- Lauren Crossman
- Crossroads Hospice of Cincinnati, LLC
- Crosstrees Counseling, LLC
- Alyssia D Crossty
- Keyanna Crossty
- Shakeeta Crossty
All providers in Cincinnati, OH · Community Based Hospice Care Agency in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 14, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.