Mary T Home Health Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

379633 Issued in MN

Legal business name

MARY T HOME HEALTH INC

Doing business as

Mary T Home Health - Hospice

Practice address

299 Coon Rapids Blvd NW Ste 204
Coon Rapids, MN 55433-5870

Phone

(763) 772-9963

Fax

(763) 772-9962

NPI assigned

Jan 14, 2009

Last updated

Jun 24, 2022By the provider in NPPES

Organization subpart

Yes

Parent organization

MARY T ASSOCIATES INCAs reported in NPPES

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

Authorized official

Name

Jason Tjosvold

Title

Cao

Phone

(763) 567-8951

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mary T Home Health - Hospice Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346487238. Details of each certification follow.

• CCN 241587 Hospice · Active · Details

Hospice certification: CCN 241587

Legal name

MARY T HOME HEALTH INC

Doing business as

MARY T HOSPICE

Certification status

Active

Provider type (POS)

Hospice

Participating since

Feb 17, 2010

Last certification

Feb 17, 2010

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Jan 4, 1995 in MN

Enrollment address

11777 Xeon Blvd NW
Coon Rapids, MN 55448-2060

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Mary T Home Health Inc

  • Home Health Agency
  • Coon Rapids, MN
  • NPI 1497923346

  4880618131

  Same PAC ID

Listed as

Mary T HospiceCCN 241587 · All quality measures

Ownership

For-Profit

Certified

Feb 17, 2010

Medicare certification status

ActiveFrom the Provider of Services file

Part of

Mary T Associates Inc

Locations

All disclosed owners & managing parties 9

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.

• Lora Elane Shirar, MD

  • Family Medicine Physician
  • Golden, CO
  • NPI 1528013000

  Contracted Managing Employee

  CMS ownership

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• Mary T Home Health Inc

  • Home Health Agency
  • Coon Rapids, MN
  • NPI 1497923346

  Mary T Associates Inc

  CMS ownership

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Mary T Associates Inc

  • Home Health Agency
  • Coon Rapids, MN
  • NPI 1770643694
  NPPES parent name

Affiliated clinicians 1

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

• Brian Lewis, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Golden Valley, MN
  • NPI 1235525015

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1231891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656028800000",
    "number": "1346487238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "299 COON RAPIDS BLVD NW STE 204",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554335870",
            "telephone_number": "763-772-9963",
            "fax_number": "763-772-9962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "299 COON RAPIDS BLVD NW STE 204",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554335870",
            "telephone_number": "763-772-9963",
            "fax_number": "763-772-9962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY T HOME HEALTH INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARY T ASSOCIATES INC",
        "enumeration_date": "2009-01-14",
        "last_updated": "2022-06-24",
        "certification_date": "2022-06-24",
        "status": "A",
        "authorized_official_last_name": "TJOSVOLD",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CAO",
        "authorized_official_telephone_number": "763-567-8951"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MN",
            "license": "379633",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "379633",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mary T Home Health - Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mary T Home Health - Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Joshua A Martini, MD
• Cynthia J Martinson, CRNA
• Faith Marty
• Marissa Emily Marx, LPCC
• Mary T Associates Inc
• Mary T Home Health Inc
• Mary T Hospice
• Mary T Outpatient
• Beth Tuttle Maschoff, RDN, LD
• Jael Masi

• Community Based Hospice Care Agency in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Community Based Hospice Care Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2022; 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.