Pruitthealth Hospice, Inc.
Organization Active NPI Community Based Hospice Care Agency · Norcross, GA
NPI 1316985336 · NPPES record last updated Sep 15, 2021
Key facts
- NPI
- 1316985336
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- PRUITTHEALTH HOSPICE, INC.
- Practice address
- 1626 Jeurgens CT
Norcross, GA 30093-2219 - Phone
- (404) 292-2081
- Fax
- (404) 297-4647
- NPI assigned
- Jun 2, 2006
- Organization subpart
- No
Authorized official
- Name
- Neil L Pruitt Jr.
- Title
- Chairman and Ceo
- Phone
- (770) 279-6200
Other NPIs on the same Medicare enrollment 13
Other NPIs with the same Medicare PAC ID 17
Corporate family (same tax ID) 24
Facilities with the same owner 123
Practitioners 43
-
Hannah Manboah-Rockson, AGPCNP-BC
-
Erin Michelle Smith, FNP-BC
-
Ama Browne, NP
-
Cynthia Jill Martin Clark, FNP-C
-
Kendra Jordan Cook, APRN/NP
-
Jenna M Darby, MSN, FNP
-
Janet Annikki Dits-Rinta-Koski, RN, MSN, AGNP-C
-
Lesa R Johnson, FNP
-
Liza Kim Klein, FNP-C
-
Jake Paul Lundquist, FNP-C
-
Robert Perry, NP
-
Megan Stephens, FNP-C
-
Heather Hearn Tejeda, FNP-C
-
Tina Sims Youmans, APRN
-
Valorie M Bogue, NP-C
-
Ashley Brimmer, FNP-C
-
Stacey Lynn Childress, AGPCNP
-
Kristin Claude, APRN
Affiliated clinicians 8
-
Frank David Curvin, M.D.
-
Vamsi Kanagala, M.D.
-
Byron Thomas Kelly, M.D.
-
Roman Antone Hill, M.D.
Medicare Care Compare: Hospice
- Listed as
- Pruitthealth Hospice and Palliative Care-Atlanta
- Ownership
- For-Profit
- Certified
- Dec 14, 1993
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 11D1041153 | Pruitthealth Hospice, Inc | Certificate of waiver | Aug 28, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in GA
Hospice certification: CCN 111533
- Legal name
- PRUITTHEALTH HOSPICE INC
- Doing business as
- PRUITTHEALTH HOSPICE - ATLANTA
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Dec 14, 1993
- Last certification
- Feb 9, 2022
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- Corporation · Proprietary
- Incorporated
- Oct 14, 1993 in GA
- Enrollment address
- 5365 Oakbrook Pkwy
Norcross, GA 30093-2250
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| United Health Services Inc |
5% Or Greater Indirect Ownership Interest | Jan 2, 2006 | 100% |
| Philip W. Small |
Corporate Director |
Sep 17, 2013 | |
| Pruitthealth Inc |
5% Or Greater Direct Ownership Interest | Jan 1, 2022 | |
| Operational/Managerial Control | Jan 7, 2008 | ||
| Lisa P Hamby Trust |
5% Or Greater Indirect Ownership Interest | Jan 2, 2006 | 31.65% |
| Neil Little Pruitt |
Corporate Officer |
Feb 23, 2007 | |
| Corporate Director |
Feb 23, 2007 | ||
| Other |
Jan 2, 2006 | ||
| Neil L Pruitt Jr Trust |
5% Or Greater Indirect Ownership Interest | Jan 2, 2006 | 35.93% |
| Nancy W Pruitt |
Corporate Officer |
Jan 2, 2006 | |
| Uhs-Pruitt Holdings, Inc. |
5% Or Greater Indirect Ownership Interest | Jan 2, 2006 | 100% |
| Thomas R Beddingfield |
Corporate Director |
Sep 17, 2013 | |
| United Health Services of Georgia, Inc. |
5% Or Greater Direct Ownership Interest | Jan 7, 2008 | 99% |
| J Paige Pruitt Trust |
5% Or Greater Indirect Ownership Interest | Jan 2, 2006 | 31.32% |
| Monica Hollison Peebles |
W-2 Managing Employee |
Nov 13, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060308000165 | GA | Part a Provider - Hospice | 2264344217 |
1 other NPI on this enrollment Practice locations: Norcross, GA |
| O20190702003113 | GA | Part B Supplier - Clinic/Group Practice | 2264344217 |
Receives reassigned benefits from 45 practitioners 12 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Watkinsville, GA; Augusta, GA; Valdosta, GA; Union City, GA; Swainsboro, GA; Savannah, GA; Rome, GA; Macon, GA… |
National Provider Directory
- Tax ID family
- Pruitthealth Hospice Inc
Locations
4148 Carroll St SW
Covington, GA 30014
Phone (770) 786-0427
5365 Oakbrook Pkwy
Norcross, GA 30093
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospice and Palliative Medicine (Internal Medicine) Physician |
207RH0002X | |||
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
1626 Jeurgens CT
Norcross, GA 30093-2219
Mailing address
1626 Jeurgens Court
Legal Dept
Norcross, GA 30093-2219
Phone (770) 279-6200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00587518A | Medicaid | GA |
Other names
- PruittHealth Hospice - Atlanta
NPI Registry JSON
{
"created_epoch": "1149206400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1631664000000",
"number": "1316985336",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1626 JEURGENS COURT",
"address_2": "LEGAL DEPT",
"city": "NORCROSS",
"state": "GA",
"postal_code": "300932219",
"telephone_number": "770-279-6200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1626 JEURGENS CT",
"city": "NORCROSS",
"state": "GA",
"postal_code": "300932219",
"telephone_number": "404-292-2081",
"fax_number": "404-297-4647"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PRUITTHEALTH HOSPICE, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-02",
"last_updated": "2021-09-15",
"certification_date": "2021-09-15",
"status": "A",
"authorized_official_last_name": "PRUITT",
"authorized_official_first_name": "NEIL",
"authorized_official_middle_name": "L",
"authorized_official_title_or_position": "CHAIRMAN AND CEO",
"authorized_official_telephone_number": "770-279-6200",
"authorized_official_name_suffix": "Jr."
},
"taxonomies": [
{
"code": "207RH0002X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine, Hospice and Palliative Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00587518A",
"state": "GA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "PruittHealth Hospice - Atlanta",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "PruittHealth Hospice - Atlanta",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Norcross, GA
- Pruitthealth Care Management, Inc.
- Pruitthealth Diagnostic Services, Inc.
- Pruitthealth Family First, Inc.
- Pruitthealth Home Health - Florida, Inc.
- Pruitthealth Home Health, Inc.
- Pruitthealth Nutritional Supply, Inc.
- Pruitthealth Pharmacy Services - Atlanta, Inc.
- Pruitthealth Pharmacy Services - Atlanta, Inc.
- Pruitthealth Pharmacy Services - Atlanta, Inc.
- Pruitthealth Pharmacy Services - Norcross, Inc.
All providers in Norcross, GA · Community Based Hospice Care Agency in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.