Aegis Hospice Care

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

AEGIS HOSPICE CARE

Practice address

4959 Palo Verde St Ste 206C-4
Montclair, CA 91763-2341

Phone

(909) 492-4257

Fax

(909) 687-2661

NPI assigned

Sep 7, 2016

Last updated

Sep 7, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Aris A Petrona, LVN

Title

Coo

Phone

(909) 492-4257

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336696376. Details of each certification follow.

• CCN A11741 Hospice · Active · Details

Hospice certification: CCN A11741

Legal name

AEGIS HOSPICE CARE

Certification status

Active

Provider type (POS)

Hospice

Participating since

Feb 14, 2021

Last certification

Feb 14, 2021

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Enrollment address

4959 Palo Verde St
Ste 206C-4
Montclair, CA 91763-2341

Listed as

Aegis Hospice CareCCN A11741 · All quality measures

Ownership

For-Profit

Certified

Feb 14, 2021

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.

• Phillip Tafoya, MD

  • Specialist
  • Temecula, CA
  • NPI 1073509469

  W-2 Managing Employee

  CMS ownership

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

{
    "created_epoch": "1473206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1473206400000",
    "number": "1336696376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4959 PALO VERDE ST STE 206C-4",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917632341",
            "telephone_number": "909-492-4257",
            "fax_number": "909-687-2661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4959 PALO VERDE ST STE 206C-4",
            "city": "MONTCLAIR",
            "state": "CA",
            "postal_code": "917632341",
            "telephone_number": "909-492-4257",
            "fax_number": "909-687-2661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AEGIS HOSPICE CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-07",
        "last_updated": "2016-09-07",
        "status": "A",
        "authorized_official_last_name": "PETRONA",
        "authorized_official_first_name": "ARIS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "909-492-4257",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LVN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Action Medical Supply and Equipment Inc.
• Therese Adjivon
• Jaquelin Carin Jones Adler
• Advance Pharmacy Services Inc (Montclair Pharmacy)
• Advanced Wellness Home Care Inc.
• Affective Hospice Care, Inc.
• Affirm Hospice Care, Inc.
• Afshin Shamaizadeh DDS Inc
• Agape Elitecare Solutions LLC
• Esther Phillips Agepogu, PA-C

• Community Based Hospice Care Agency in Montclair, CA
• Providers in Montclair, 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 Sep 7, 2016; 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.