NPIMap

Organization Active NPI

Custom Hospice, LLC

  • Adult Health Nurse Practitioner
  • Troy, MI
National Provider Identifier
1306480538
Registry record updated Mar 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
Legal business name
CUSTOM HOSPICE, LLC
Doing business as
Custom Palliative Care
Practice address
888 W Big Beaver Rd Ste 900
Troy, MI 48084-4771
Phone
(866) 952-9003
Fax
(866) 952-9004
NPI assigned
Oct 31, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2021

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

Authorized official

Name
Sean Fossee
Title
Ceo
Phone
(248) 629-2880

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LA2200X Primary

Addresses

Primary practice location

888 W Big Beaver Rd Ste 900
Troy, MI 48084-4771

Mailing address

888 W Big Beaver Rd Ste 900
Troy, MI 48084-4771
Phone (866) 952-9003

Other names 1

  • Custom Palliative Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191211003133 MI Part B Supplier - Clinic/Group Practice 8820242993 Receives reassigned benefits from 3 practitioners
Practice locations: Troy, MI

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
Advanced Pro Hospice LLC2 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.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

2075 W Big Beaver Rd
Ste 601
Troy, MI 48084
Phone (248) 649-5250

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1572480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1616025600000",
    "number": "1306480538",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "888 W BIG BEAVER RD STE 900",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480844771",
            "telephone_number": "866-952-9003",
            "fax_number": "866-952-9004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "888 W BIG BEAVER RD STE 900",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480844771",
            "telephone_number": "866-952-9003",
            "fax_number": "866-952-9004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CUSTOM HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-31",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A",
        "authorized_official_last_name": "FOSSEE",
        "authorized_official_first_name": "SEAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "248-629-2880"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Custom Palliative Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Custom Palliative Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Troy, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 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.