Lifespark Hospice, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

LIFESPARK HOSPICE, LLC

Practice address

5320 W 23Rd St Ste 130
St Louis Park, MN 55416-1670

Phone

(952) 737-4350

Fax

(952) 737-4351

NPI assigned

Nov 4, 2019

Last updated

May 2, 2022By 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

Brianna Lindeland

Title

Sr Compliance Specialist

Phone

(612) 286-1150

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 1295379154. Details of each certification follow.

• CCN 241610 Hospice · Active · Details

Hospice certification: CCN 241610

Legal name

LIFESPARK HOSPICE, LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Jul 13, 2020

Last certification

Jul 13, 2020

Ownership / control type

Proprietary - Corporation

Organization structure

LLCProprietary

Incorporated

Oct 18, 2019 in DE

Enrollment address

5320 W 23Rd St
Ste 130
St Louis Park, MN 55416-1670

Listed as

Lifesprk Hospice LLCCCN 241610 · All quality measures

Ownership

For-Profit

Certified

Jul 13, 2020

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 1

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

• Nicholas J Schneeman, MD

  • Geriatric Medicine (Family Medicine) Physician
  • Robbinsdale, MN
  • NPI 1245269612

  W-2 Managing Employee

  CMS ownership

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• Lifespark Home Health LLC

  • Home Health Agency
  • St Louis Park, MN
  • NPI 1407223282

  Joel D. Thiesen Revocable Intervivos Trust U/a/D October 6, 2008, Lifesprk Holdings, Inc., Lifesprk LLC, Solutions Home Care Inc, Ucare Minnesota, Virgo-Vesta LLC

  CMS ownership

Affiliated clinicians 4

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

• Erin Phaedra Emerson Egginton, DO

  • Family Medicine Physician
  • Minneapolis, MN
  • NPI 1609040054

  Hospice

  Care Compare affiliation
• Wendy Laine, MD

  • General Practice Physician
  • St Louis Park, MN
  • NPI 1033178199

  Hospice

  Care Compare affiliation
• Nicholas J Schneeman, MD

  • Geriatric Medicine (Family Medicine) Physician
  • Robbinsdale, MN
  • NPI 1245269612

  Hospice

  Care Compare affiliation
• James A Young II, MD

  • Family Medicine Physician
  • Saint Paul, MN
  • NPI 1538126107

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1572825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651449600000",
    "number": "1295379154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5320 W 23RD ST STE 130",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554161670",
            "telephone_number": "952-737-4350",
            "fax_number": "952-737-4351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5320 W 23RD ST STE 130",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554161670",
            "telephone_number": "952-737-4350",
            "fax_number": "952-737-4351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFESPARK HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-04",
        "last_updated": "2022-05-02",
        "certification_date": "2022-05-02",
        "status": "A",
        "authorized_official_last_name": "LINDELAND",
        "authorized_official_first_name": "BRIANNA",
        "authorized_official_title_or_position": "SR COMPLIANCE SPECIALIST",
        "authorized_official_telephone_number": "612-286-1150"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lifeclinic PA
• Lifeclinic Rehabilitation and Chiropractic
• Lifescan Minnesota Stand Up MRI LLC
• Lifespark Home Health LLC
• Lifespark Home Health LLC
• Lifespark Medical Group, PA (Lifesprk Health)
• Lifespark Medical Group, PA (Lifespark Medical Group)
• Lighthouse Residential Services LLC
• Lili Group Inc
• Joshua Limberg

• Community Based Hospice Care Agency in St Louis Park, MN
• Providers in St Louis Park, 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 May 2, 2022; 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.