Active NPI
Aegis Hospice, Inc
Doing business as Aegis Hospice
- Community Based Hospice Care Agency
- Mesa, AZ
National Provider Identifier
1356614754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- Legal business name
- AEGIS HOSPICE, INC
- Doing business as
- Aegis Hospice
- Practice address
- 7227 E Baseline Rd Ste 129
Mesa, AZ 85209-5006 - Phone
- (480) 219-4790
- Fax
- (480) 584-5871
- NPI assigned
- Feb 15, 2012
- Last updated
- Aug 22, 2022
- 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
- Benjamin Larsen
- Title
- Administrator
- Phone
- (435) 754-4962
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | AZ | Primary | |
| Inpatient Hospice | 315D00000X | NU |
Addresses
Primary practice location
7227 E Baseline Rd Ste 129
Mesa, AZ 85209-5006
Mailing address
7227 E Baseline Rd Ste 129
Mesa, AZ 85209-5006
Phone (480) 219-4790
Other practice location 1
4950 S Lindsay Rd Bldg F
Chandler, AZ 85249-9203
Phone (480) 219-4790
Other names 1
- Aegis Hospice
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120618000186 | CA | Part A Provider - Hospice | 6507020856 | Practice locations: Mesa, AZ |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1356614754. Details of each certification follow.
Hospice certification: CCN 031613
- Legal name
- AEGIS HOSPICE, INC
- Doing business as
- AEGIS HOSPICE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Feb 6, 2013
- Last certification
- May 13, 2022
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- Corporation
- Incorporated
- Feb 14, 2012 in AZ
- Enrollment address
- 7227 E Baseline Rd
Ste 129
Mesa, AZ 85209-5006
Care Compare: Hospice
Medicare Care Compare- Listed as
- Aegis Hospice, Inc.
- Ownership
- For-Profit
- Certified
- Feb 6, 2013
- Medicare certification status
- Active
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 03D2038145 | Aegis Hospice, Inc | Certificate of waiver | Mar 12, 2028 |
| 03D2256740 | Aegis Hospice | Certificate of waiver | Mar 27, 2028 |
National Provider Directory
National Provider DirectoryLocations
2250 E Germann Rd
Ste 1
Chandler, AZ 85286
Phone (480) 219-4790
2350 E Germann Rd
Ste 31
Chandler, AZ 85286
Phone (480) 219-4790
4950 S Lindsay Rd
Bldg F
Chandler, AZ 85249
Phone (480) 219-4790
7227 E Baseline Rd
Ste 129
Mesa, AZ 85209
Phone (480) 219-4790
Ownership & related parties
All disclosed owners & managing parties 11
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 |
|---|---|---|---|
| Margene Farnsworth Burk | W-2 Managing Employee | Feb 1, 2024 | |
| Bradley Butcher | W-2 Managing Employee | Feb 1, 2024 | |
| Benjamin Larsen | 5% Or Greater Direct Ownership Interest | Sep 1, 2025 | 37.5% |
| Corporate Officer | Sep 1, 2025 | 37.5% | |
| Corporate Director | Sep 1, 2025 | ||
| Tyler Franklin Pace | 5% Or Greater Direct Ownership Interest | Sep 1, 2025 | 25% |
| General Partnership Interest | Sep 1, 2025 | 25% | |
| Michael Tawadrous | Contracted Managing Employee | Apr 1, 2020 | |
| Sadek R Ebeid | Contracted Managing Employee | Oct 1, 2017 | |
| Tyler Labrum | W-2 Managing Employee | Jan 18, 2023 | |
| Robert Carl Schreiman | Contracted Managing Employee | Sep 15, 2025 | |
| Kasandra Burk Heapes | W-2 Managing Employee | Feb 1, 2024 | |
| Nicholas a Larsen | 5% Or Greater Direct Ownership Interest | Sep 1, 2025 | 37.5% |
| General Partnership Interest | Sep 1, 2025 | 37.5% | |
| Corporate Officer | Sep 1, 2025 | ||
| Corporate Director | Sep 1, 2025 | ||
| Sara Michelle Robinson | W-2 Managing Employee | Sep 1, 2025 |
Owners & managing parties with NPI records 3
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Family Medicine Physician
- Chandler, AZ
- NPI 1972892339
Contracted Managing Employee
-
- Geriatric Medicine (Family Medicine) Physician
- Huntington Beach, CA
- NPI 1871605196
Contracted Managing Employee
Practitioners & affiliated clinicians
Affiliated clinicians 34
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": "1329264000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1661126400000",
"number": "1356614754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7227 E BASELINE RD STE 129",
"city": "MESA",
"state": "AZ",
"postal_code": "852095006",
"telephone_number": "480-219-4790",
"fax_number": "480-584-5871"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7227 E BASELINE RD STE 129",
"city": "MESA",
"state": "AZ",
"postal_code": "852095006",
"telephone_number": "480-219-4790",
"fax_number": "480-584-5871"
}
],
"practiceLocations": [
{
"address_1": "4950 S Lindsay Rd Bldg F",
"address_purpose": "LOCATION",
"city": "Chandler",
"state": "AZ",
"postal_code": "852499203",
"country_code": "US",
"telephone_number": "480-219-4790",
"fax_number": "480-584-5871",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "AEGIS HOSPICE, INC",
"organizational_subpart": "NO",
"enumeration_date": "2012-02-15",
"last_updated": "2022-08-22",
"certification_date": "2022-08-22",
"status": "A",
"authorized_official_last_name": "LARSEN",
"authorized_official_first_name": "BENJAMIN",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "435-754-4962"
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": "AZ",
"license": null,
"primary": true
},
{
"code": "315D00000X",
"taxonomy_group": "",
"desc": "Hospice, Inpatient",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Aegis Hospice",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Aegis Hospice",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.