Casper Home Health, LLC
Organization Active NPI Home Health Agency · Casper, WY
NPI 1336652452 · NPPES record last updated Feb 12, 2021
Key facts
- NPI
- 1336652452
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- Legal business name
- CASPER HOME HEALTH, LLC
- Practice address
- 126 N Wilson St
Casper, WY 82601-2741 - Phone
- (307) 439-4110
- NPI assigned
- Nov 10, 2017
- Organization subpart
- No
Authorized official
- Name
- Marc Berg
- Title
- Ceo
- Phone
- (360) 518-3226
Affiliated clinicians 25
-
Mary Frances Burke, M.D.
-
Sherrill A Fox, M.D.
-
Larissa Faith Gray, PA-C
-
Amy Marie Gruwell, FNP
-
Stacy Legler Henley, FNP-BC
-
Julie Lynn Johnson, APRN
-
Sharon R Karnes, M.D.
-
Eric Lawrence, DO
-
Karli McMillan, D.O.
-
Ashley Oviedo-Lopez, FNP-BC
-
Joseph K Schoeber, M.D.
-
Tina M Stanco, MD
-
Rebecca M Tharp, DNP, FNP-C, APRN
-
Tabitha Lucynda Thrasher, D,O.
-
Marjorie Lynn Wells, M.D.
-
Joseph P Coppola, DO
Medicare Care Compare: Home health agency
- Listed as
- Casper Home Health LLC
- Overall star rating
- ★★★★★ 5 of 5
- Ownership
- Proprietary
- Certified
- Dec 4, 2018
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Physical therapy, Speech pathology, Occupational therapy
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 53D2150727 | Casper Home Health Care LLC | Certificate of waiver | Jul 1, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WY
Home health agency certification: CCN 537084
- Legal name
- CASPER HOME HEALTH, LLC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Dec 4, 2018
- Last certification
- Nov 1, 2018
- Ownership / control type
- Proprietary
- Organization structure
- LLC · Proprietary
- Incorporated
- Jun 2, 2017 in WY
- Enrollment address
- 126 N Wilson St
Casper, WY 82601-2741
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Nicholas GJ Healey |
5% Or Greater Direct Ownership Interest | Dec 31, 2018 | 23.4% |
| Marc a Berg |
5% Or Greater Direct Ownership Interest |
Jun 2, 2017 | 23.4% |
| Katherine Klein |
5% Or Greater Direct Ownership Interest | Aug 1, 2018 | 13.3% |
| W-2 Managing Employee |
Aug 1, 2018 | 13.3% | |
| Susan Murtha |
5% Or Greater Direct Ownership Interest |
Jun 2, 2017 | 6.6% |
| Valan Pearse |
5% Or Greater Direct Ownership Interest |
Jun 2, 2017 | 20% |
| W-2 Managing Employee |
Jun 2, 2017 | ||
| Marie Ryan |
5% Or Greater Direct Ownership Interest |
Jun 2, 2017 | 13.3% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20180618001099 | WY | Part a Provider - Home Health Agency | 2264787142 | Practice locations: Casper, WY |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes |
Addresses
Primary practice location
126 N Wilson St
Casper, WY 82601-2741
Mailing address
PO Box 381
Casper, WY 82602-0381
Phone (307) 439-4110
Other providers in Casper, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 12, 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.