Bristol Hospice - Green Bay, L.L.C.
Organization Active NPI Community Based Hospice Care Agency · Green Bay, WI
NPI 1356928154 · NPPES record last updated Feb 27, 2026
Key facts
- NPI
- 1356928154
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- BRISTOL HOSPICE - GREEN BAY, L.L.C.
- Practice address
- 2450 Velp Ave Ste 101
Green Bay, WI 54303-6593 - Phone
- (920) 278-2499
- Fax
- (920) 328-9052
- NPI assigned
- Mar 26, 2021
- Organization subpart
- Yes
- Parent organization (as reported)
- BRISTOL HOSPICE, L.L.C.
Authorized official
- Name
- Mr. Alex Mauricio
- Title
- President and Ceo
- Phone
- (801) 325-0175
Owners & managing parties with NPI records 1
-
Scott Robert Schinschke, D.O.
Facilities with the same owner 52
Affiliated clinicians 24
-
Emmanouil Alimpertis, M.D.
-
Deborah Ann Bartmann, APNP
-
James Bruno, DO
-
Paula Lynn Ferron, APNP
-
Jessica Marie Flaeschel, APNP
-
Kayla Rene' Guns, FNP-BC
-
Jacqueline Karlin, APRN
-
Kassondra K Korth, APNP
-
Jamie L Lodes, APNP
-
Emily Moon, APNP
-
Rebecca J Philpot, APNP
-
Kristen A Powell, M.D.
-
Olivia Quade, NP
-
Scott Robert Schinschke, D.O.
-
Pawneet P Singh, MD
-
Randi L Wagner, APNP
-
James M Williams, MD
-
Jolene C Wittmann, APNP
Medicare Care Compare: Hospice
- Listed as
- Bristol Hospice Green Bay
- Ownership
- For-Profit
- Certified
- May 17, 2022
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 52D2243060 | Bristol Hospice - Green Bay, LLC | Certificate of waiver | Nov 15, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Hospice certification: CCN 521610
- Legal name
- BRISTOL HOSPICE - GREEN BAY, L.L.C.
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- May 17, 2022
- Last certification
- May 17, 2022
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- LLC · Proprietary
- Incorporated
- Jan 28, 2021 in DE
- Enrollment address
- 2450 Velp Ave
Ste 101
Green Bay, WI 54303-6593
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Bristol Hospice Holdings Inc |
5% Or Greater Indirect Ownership Interest | Jan 28, 2021 | 100% |
| Alex Edward Mauricio |
Corporate Officer |
Jan 1, 2023 | |
| Corporate Director |
Jan 1, 2023 | ||
| Webster Equity Partners Bristol CF LP |
5% Or Greater Indirect Ownership Interest | Jan 25, 2022 | 69.8% |
| John Charles Garbarino |
Corporate Officer |
Jan 28, 2021 | |
| Corporate Director |
Jan 28, 2021 | ||
| Webster Equity Partners IV Bristol CF LP |
5% Or Greater Indirect Ownership Interest | Jan 25, 2022 | 5.72% |
| Michael Derrick |
Corporate Officer |
Sep 1, 2023 | |
| Corporate Director |
Sep 1, 2023 | ||
| Betty J Brennan |
Corporate Director |
Jul 13, 2018 | |
| Bristol Ultimate Holdco, LP |
5% Or Greater Indirect Ownership Interest | Jan 28, 2021 | 100% |
| Scott R Schinschke |
Contracted Managing Employee |
May 15, 2021 | |
| Hyrum Kirton |
Corporate Director |
Oct 26, 2020 | |
| Aware Super Pty, LTD. |
5% Or Greater Indirect Ownership Interest | Jan 24, 2022 | 8.28% |
| Bristol Hospice, L.L.C. |
5% Or Greater Direct Ownership Interest | Jan 28, 2021 | 100% |
| Ally Schauer |
W-2 Managing Employee |
Jul 21, 2025 | |
| Bristol Hospice Topco Inc |
5% Or Greater Indirect Ownership Interest | Jan 28, 2021 | 100% |
| David a Malm |
Corporate Officer |
Jan 28, 2021 | |
| Corporate Director |
Jan 28, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220314000964 | WI | Part a Provider - Hospice | 6002201894 | Practice locations: Green Bay, WI |
National Provider Directory
- Part of
- Bristol Hospice LLC
Locations
2450 Velp Ave
Ste 101
Green Bay, WI 54303
Phone (801) 325-0175
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
2450 Velp Ave Ste 101
Green Bay, WI 54303-6593
Mailing address
206 N 2100 W Ste 202
Salt Lake City, UT 84116-4741
Phone (801) 325-0175
Other providers in Green Bay, WI
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- Andrea Bries
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- Denise Mary Brilliant
- Nylene Brittain
- Michael J Brockman
- Erin Joanne Broda
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All providers in Green Bay, WI · Community Based Hospice Care Agency in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 27, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.