KFCM Ventures, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

KFCM VENTURES, LLC

Doing business as

Nevada Prime Hospice

Practice address

4775 S Durango Dr Ste 104
Las Vegas, NV 89147-8157

Phone

(702) 691-4380

Fax

(702) 691-4381

NPI assigned

Jul 21, 2022

Organization subpart

No

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

Authorized official

Name

Mr. Kevin Ocampo

Title

Administrator

Phone

(702) 691-4380

Specialties & licenses 1

Addresses

Other names 1

• Nevada Prime Hospice Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Hospice certification: CCN 291654

Legal name

KFCM VENTURES LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Jul 28, 2023

Last certification

Jul 19, 2023

Organization structure

LLCProprietary

Enrollment address

4775 S Durango Dr
Ste 104
Las Vegas, NV 89147-8157

Listed as

Nevada Prime HospiceCCN 291654 · All quality measures

Certified

Jul 28, 2023

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 6

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.

• Ajay K. Nellutla, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Las Vegas, NV
  • NPI 1407913718

  Contracted Managing Employee

  CMS ownership

Affiliated clinicians 1

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

• Ajay K. Nellutla, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Las Vegas, NV
  • NPI 1407913718

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1658361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1306571443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4775 S DURANGO DR STE 104",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891478157",
            "telephone_number": "702-691-4380",
            "fax_number": "702-691-4381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4775 S DURANGO DR STE 104",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891478157",
            "telephone_number": "702-691-4380",
            "fax_number": "702-691-4381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KFCM VENTURES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-07-21",
        "last_updated": "2022-07-21",
        "certification_date": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "OCAMPO",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "702-691-4380",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "ConnectURL",
            "affiliation": "N",
            "endpointDescription": "ConnectURL",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "ConnectURL",
            "address_1": "4775 S Durango Dr Ste 104",
            "city": "Las Vegas",
            "state": "NV",
            "country_code": "US",
            "postal_code": "891478157",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Nevada Prime Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jeffrey Scott Keysar, D.C.
• Eric J Keyser, MD
• Keystone Counseling and Consulting, LLC
• Keystone Development Center
• Keystone Prado LLC
• Susan Khabbaz
• George Khabro
• Basemmah Khachatryan
• Dzhulyeta Khachatryan
• Haykuhi Khachatryan

• Community Based Hospice Care Agency in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Community Based Hospice Care Agency in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.