NPIMap

Organization Active NPI

Evergreen Hospice Care, LLC

  • Community Based Hospice Care Agency
  • Olathe, KS
National Provider Identifier
1356749527
Registry record updated Dec 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
EVERGREEN HOSPICE CARE, LLC
Practice address
11875 S Sunset Dr
Suite 200
Olathe, KS 66061-2793
Phone
(913) 477-8252
NPI assigned
Dec 19, 2014
Last updated
Dec 19, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
EVERGREEN LIVING INNOVATIONS, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 19, 2014

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

Authorized official

Name
Mr. Christopher Osborn, R.N.
Title
Chief Operating Officer
Phone
(913) 477-8252

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X NU Primary

Addresses

Primary practice location

11875 S Sunset Dr
Suite 200
Olathe, KS 66061-2793

Mailing address

11875 S Sunset Dr
Suite 200
Olathe, KS 66061-2793
Phone (913) 477-8252

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150602001780 KS Part A Provider - Hospice 6002137171 Practice locations: Olathe, KS

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356749527. Details of each certification follow.

Hospice certification: CCN 171595

Legal name
EVERGREEN HOSPICE CARE LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Dec 11, 2015
Last certification
Dec 11, 2015
Ownership / control type
Other
Organization structure
LLCNon-profit
Incorporated
Dec 19, 2014 in KS
Enrollment address
11875S Sunset Dr 200
Olathe, KS 66061-2793

Care Compare: Hospice

Medicare Care Compare
Listed as
Evergreen Hospice Care LLCCCN 171595 · All quality measures
Ownership
Non-Profit
Certified
Dec 11, 2015
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Part of
Evergreen Living Innovations Inc

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

11875 S Sunset Dr
Ste 200
Olathe, KS 66061
Phone (913) 477-8227

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
C Thomas Dupriest Individual Corporate DirectorBoard Member Jan 20, 2015
Mark Kevin Dwyer Individual Corporate DirectorBoard Member Jan 20, 2015
Lisa Belden Individual W-2 Managing EmployeeHospice Director Jan 6, 2015
Jason M Wesco Individual Corporate OfficerPresident Jan 20, 2015
Christopher M Osborn Individual Corporate OfficerCoo Dec 9, 2014
Evergreen Living Innovations Inc Organization, Olathe, KS 5% Or Greater Direct Ownership Interest Dec 9, 2014 100%
Operational/Managerial Control Dec 9, 2014
Michele a Haney Individual Corporate OfficerTreasurer Dec 9, 2014
Chad H Butterfield Individual Corporate DirectorBoard Member Jan 20, 2015

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 1

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

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.

Practitioners & affiliated clinicians

Affiliated clinicians 2

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": "1418947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418947200000",
    "number": "1356749527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11875 S SUNSET DR",
            "address_2": "SUITE 200",
            "city": "OLATHE",
            "state": "KS",
            "postal_code": "660612793",
            "telephone_number": "913-477-8252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11875 S SUNSET DR",
            "address_2": "SUITE 200",
            "city": "OLATHE",
            "state": "KS",
            "postal_code": "660612793",
            "telephone_number": "913-477-8252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN HOSPICE CARE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EVERGREEN LIVING INNOVATIONS, INC.",
        "enumeration_date": "2014-12-19",
        "last_updated": "2014-12-19",
        "status": "A",
        "authorized_official_last_name": "OSBORN",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "913-477-8252",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Olathe, KS

Sources for this page

Verify at the official NPI Registry.