NPIMap

Organization Active NPI

Main Street Hospice, LLC

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Franklin, IN
National Provider Identifier
1295301216
Registry record updated Sep 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Internal Medicine) PhysicianTaxonomy code 207RH0002X
Legal business name
MAIN STREET HOSPICE, LLC
Practice address
10 Highland Ave
Franklin, IN 46131-1230
Phone
(317) 736-0055
Fax
(317) 739-3505
NPI assigned
Jun 1, 2021
Last updated
Sep 3, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2021

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

Authorized official

Name
Douglas Keith Weddle
Title
Cfo
Phone
(317) 736-0055

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X NU
Adult Health Nurse Practitioner 363LA2200X NU
Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X NU Primary

Addresses

Primary practice location

10 Highland Ave
Franklin, IN 46131-1230

Mailing address

10 Highland Ave
Franklin, IN 46131-1230
Phone (317) 736-0055

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210713000155 IN Part B Supplier - Clinic/Group Practice 4587916002 Receives reassigned benefits from 4 practitioners
Practice locations: Franklin, IN

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Americare Home Health Servicesinc2 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.

Locations

10 Highland Ave
Franklin, IN 46131
Phone (317) 736-0055

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1622505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1630627200000",
    "number": "1295301216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 HIGHLAND AVE",
            "city": "FRANKLIN",
            "state": "IN",
            "postal_code": "461311230",
            "telephone_number": "317-736-0055",
            "fax_number": "317-739-3505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 HIGHLAND AVE",
            "city": "FRANKLIN",
            "state": "IN",
            "postal_code": "461311230",
            "telephone_number": "317-736-0055",
            "fax_number": "317-739-3505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAIN STREET HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-01",
        "last_updated": "2021-09-03",
        "certification_date": "2021-09-03",
        "status": "A",
        "authorized_official_last_name": "WEDDLE",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "KEITH",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "317-736-0055"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Franklin, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.