Active NPI
Blessed Hospice California, Inc.
- Community Based Hospice Care Agency
- San Diego, CA
National Provider Identifier
1336745967
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- Legal business name
- BLESSED HOSPICE CALIFORNIA, INC.
- Practice address
- 4540 Kearny Villa Rd Ste 105
San Diego, CA 92123-1564 - Phone
- (858) 430-6656
- NPI assigned
- Dec 9, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Rachel Guha Roy
- Title
- Owner
- Phone
- (858) 430-6656
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Primary |
Addresses
Primary practice location
4540 Kearny Villa Rd Ste 105
San Diego, CA 92123-1564
Mailing address
4540 Kearny Villa Rd Ste 105
San Diego, CA 92123-1564
Phone (858) 430-6656
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20201224000001 | CA | Part A Provider - Hospice | 9931511599 | Practice locations: San Diego, CA |
Hospice certification: CCN B41582
- Legal name
- BLESSED HOSPICE CALIFORNIA, INC.
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Jun 20, 2022
- Last certification
- Jun 20, 2022
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- Corporation
- Incorporated
- Sep 4, 2020 in CA
- Enrollment address
- 4540 Kearny Villa Rd
Ste 105
San Diego, CA 92123-1564
Care Compare: Hospice
Medicare Care Compare- Listed as
- Blessed Hospice California Inc
- Certified
- Jun 20, 2022
- Medicare certification status
- Active
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 2
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Venkatesh Adigopula | 5% Or Greater Direct Ownership Interest | May 22, 2023 | 10% |
| Corporate Officer | May 22, 2023 | 10% | |
| Corporate Director | May 22, 2023 | 10% | |
| Zhike Pruett | 5% Or Greater Direct Ownership Interest | May 22, 2023 | 90% |
| W-2 Managing Employee | Sep 4, 2020 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Nurse Practitioner
- San Diego, CA
- NPI 1295086262
5% Or Greater Direct Ownership Interest, W-2 Managing Employee
Practitioners & affiliated clinicians
Affiliated clinicians 7
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607472000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1607472000000",
"number": "1336745967",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4540 KEARNY VILLA RD STE 105",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921231564",
"telephone_number": "858-430-6656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4540 KEARNY VILLA RD STE 105",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921231564",
"telephone_number": "858-430-6656"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BLESSED HOSPICE CALIFORNIA, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2020-12-09",
"last_updated": "2020-12-09",
"certification_date": "2020-12-09",
"status": "A",
"authorized_official_last_name": "GUHA ROY",
"authorized_official_first_name": "RACHEL",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "858-430-6656"
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2020; 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.