Lakeside Hospice Inc.

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

10266 Issued in AL

Legal business name

LAKESIDE HOSPICE INC.

Practice address

4010 Masters Rd
Pell City, AL 35128-7550

Phone

(205) 884-1111

Fax

(205) 884-1114

NPI assigned

Jun 8, 2005

Organization subpart

No

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

Authorized official

Name

Paul M Garing

Title

Executive Director

Phone

(205) 884-1111

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in AL

Enrollment records 1

Hospice certification: CCN 011526

Legal name

LAKESIDE HOSPICE INC.

Doing business as

ST CLAIR CARE A HOSPICE INC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Mar 28, 1991

Last certification

Jul 28, 2022

Ownership / control type

Non-Profit - Other

Organization structure

CorporationNon-profit

Incorporated

Mar 16, 1995 in AL

Enrollment address

4010 Masters Rd
Pell City, AL 35128-7550

Listed as

Lakeside Hospice IncCCN 011526 · All quality measures

Ownership

For-Profit

Certified

Mar 28, 1991

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

St Clair Care Hospice Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Lakeside Hospice Inc.

  dba Woodstock Hospice Care Facility

  • Inpatient Hospice
  • Anniston, AL
  • NPI 1023575032
  NPD tax ID

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.

• James Murray Tuck Jr., MD

  • Family Medicine Physician
  • Pell City, AL
  • NPI 1871687541

  Corporate Director, W-2 Managing Employee

  CMS ownership

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Lakeside Hospice Inc.

  dba Woodstock Hospice Care Facility

  • Inpatient Hospice
  • Anniston, AL
  • NPI 1023575032
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• James Murray Tuck Jr., MD

  • Family Medicine Physician
  • Pell City, AL
  • NPI 1871687541
  NPD

Affiliated clinicians 2

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

• Harold E. Simon, M. D.

  • Internal Medicine Physician
  • Pell City, AL
  • NPI 1740392471

  Hospice

  Care Compare affiliation
• James Murray Tuck Jr., MD

  • Family Medicine Physician
  • Pell City, AL
  • NPI 1871687541

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1118188800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549238400000",
    "number": "1346244399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4010 MASTERS RD",
            "city": "PELL CITY",
            "state": "AL",
            "postal_code": "351287550",
            "telephone_number": "205-884-1111",
            "fax_number": "205-884-1114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4010 MASTERS RD",
            "city": "PELL CITY",
            "state": "AL",
            "postal_code": "351287550",
            "telephone_number": "205-884-1111",
            "fax_number": "205-884-1114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE HOSPICE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-08",
        "last_updated": "2019-02-04",
        "status": "A",
        "authorized_official_last_name": "GARING",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "205-884-1111"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "AL",
            "license": "10266",
            "primary": true
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "P1C1526E",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "010-727",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gina Kielbasa, RN
• Jordan Crook Knudsen
• Christoph Scott Koogler
• Ingrid M Kruse, DC
• Laboratory Corporation of America Holdings
• Sabine Lamont, FNP-C
• Bekina Lane
• Ami Latham, CRNP
• James Paul Layne, R.PH.
• Leaps Academy Inc

• Community Based Hospice Care Agency in Pell City, AL
• Providers in Pell City, AL by specialty
• Community Based Hospice Care Agency in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2019; 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.