St. Markoss Hospice Inc.

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

ST. MARKOSS HOSPICE INC.

Practice address

5301 Laurel Canyon Blvd Ste 226
Valley Village, CA 91607-2788

Phone

(747) 755-2020

Fax

(747) 755-2021

NPI assigned

Aug 27, 2019

Organization subpart

No

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

Authorized official

Name

Oleg Raskopin

Title

Ceo

Phone

(747) 755-2020

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Hospice certification: CCN A11686

Legal name

ST MARKOSS HOSPICE INC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Jun 30, 2020

Last certification

Jun 30, 2020

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Enrollment address

425 E Colorado St
Suite 580a
Glendale, CA 91205-5117

Listed as

St Markoss Hospice IncCCN A11686 · All quality measures

Ownership

For-Profit

Certified

Jun 30, 2020

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 3

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.

• Paula Bailey-Walton, M.D.

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1174646590

  Operational/Managerial Control, W-2 Managing Employee

  CMS ownership

Practitioners 1

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

• Paula Bailey-Walton, M.D.

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1174646590
  NPD (past)

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

{
    "created_epoch": "1566864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679875200000",
    "number": "1306494034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5301 LAUREL CANYON BLVD STE 226",
            "city": "VALLEY VILLAGE",
            "state": "CA",
            "postal_code": "916072788",
            "telephone_number": "747-755-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5301 LAUREL CANYON BLVD STE 226",
            "city": "VALLEY VILLAGE",
            "state": "CA",
            "postal_code": "916072788",
            "telephone_number": "747-755-2020",
            "fax_number": "747-755-2021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARKOSS HOSPICE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-27",
        "last_updated": "2023-03-27",
        "certification_date": "2023-03-27",
        "status": "A",
        "authorized_official_last_name": "RASKOPIN",
        "authorized_official_first_name": "OLEG",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "747-755-2020"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Maren Stein

• Community Based Hospice Care Agency in Valley Village, CA
• Providers in Valley Village, CA by specialty
• Community Based Hospice Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2023; 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.