Big Bend Hospice, Inc.

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

5002096 Issued in FL

Legal business name

BIG BEND HOSPICE, INC.

Practice address

1723 Mahan Center Blvd
Tallahassee, FL 32308-5428

Phone

(850) 878-5310

Fax

(850) 309-1638

NPI assigned

Aug 2, 2005

Last updated

Mar 31, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

William E Wertman, MSW

Title

Ceo/Administrator

Phone

(850) 878-5310

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396746103. Details of each certification follow.

• CCN 101523 Hospice · Active · Details

Hospice certification: CCN 101523

Legal name

BIG BEND HOSPICE, INC.

Certification status

Active

Provider type (POS)

Hospice

Participating since

Jun 19, 1986

Last certification

Feb 7, 2012

Ownership / control type

Non-Profit - Private

Organization structure

CorporationNon-profit

Incorporated

Dec 28, 1983 in FL

Enrollment address

1723 Mahan Center Blvd
Tallahassee, FL 32308-5428

Listed as

Big Bend Hospice IncCCN 101523 · All quality measures

Ownership

Non-Profit

Certified

Jun 19, 1986

Medicare certification status

ActiveFrom the Provider of Services file

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Capstone Center, LLC

  • Community/Behavioral Health Agency
  • Tallahassee, FL
  • NPI 1386157360

  Member Of

  NPD member

Locations

All disclosed owners & managing parties 19

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 2

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

• David Andrew Jones, M.D.

  • Pediatrics Physician
  • Tallahassee, FL
  • NPI 1982661583

  Corporate Director, Corporate Officer

  CMS ownership
• Jeannine M Silberman, MD

  • Hematology & Oncology Physician
  • Tallahassee, FL
  • NPI 1396922654

  Corporate Director

  CMS ownership

Affiliated clinicians 22

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

• Eric S Bouchard, MD

  • Internal Medicine Physician
  • Tallahassee, FL
  • NPI 1295742740

  Hospice

  Care Compare affiliation
• William Lantz Effinger I, D.O.,M.S.

  • Family Medicine Physician
  • Tallahassee, FL
  • NPI 1225327380

  Hospice

  Care Compare affiliation
• Michael Forsthoefel, M.D.

  • Internal Medicine Physician
  • Tallahassee, FL
  • NPI 1780689356

  Hospice

  Care Compare affiliation
• Stacia Kutter Groll, M.D.

  • Family Medicine Physician
  • Tallahassee, FL
  • NPI 1841584448

  Hospice

  Care Compare affiliation
• Paul Frederick Hartsfield, M.D.

  • Family Medicine Physician
  • Tallahassee, FL
  • NPI 1912109166

  Hospice

  Care Compare affiliation
• Patricia Hogan, M.D.

  • Family Medicine Physician
  • Tallahassee, FL
  • NPI 1922030881

  Hospice

  Care Compare affiliation
• David Anthony Keen, M.D., M.P.H.

  • Family Medicine Physician
  • Crawfordville, FL
  • NPI 1295759512

  Hospice

  Care Compare affiliation
• Shaun E Laurie, M.D.

  • Internal Medicine Physician
  • Tallahassee, FL
  • NPI 1952344285

  Hospice

  Care Compare affiliation
• Judith Ann Lewis, M.D.

  • Internal Medicine Physician
  • Tallahassee, FL
  • NPI 1588621940

  Hospice

  Care Compare affiliation
• John Taylor Mackay, MD

  • Family Medicine Physician
  • Tallahassee, FL
  • NPI 1942267844

  Hospice

  Care Compare affiliation
• Chitra Mony, MD

  • Family Medicine Physician
  • Tallahassee, FL
  • NPI 1164624342

  Hospice

  Care Compare affiliation
• Edwin Jonathan Perry IV, M.D.

  • Family Medicine Physician
  • Tallahassee, FL
  • NPI 1295260578

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1122940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648684800000",
    "number": "1396746103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1723 MAHAN CENTER BLVD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323085428",
            "telephone_number": "850-878-5310",
            "fax_number": "850-309-1638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1723 MAHAN CENTER BLVD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323085428",
            "telephone_number": "850-878-5310",
            "fax_number": "850-309-1638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIG BEND HOSPICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-02",
        "last_updated": "2022-03-31",
        "certification_date": "2022-03-31",
        "status": "A",
        "authorized_official_last_name": "WERTMAN",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CEO/ADMINISTRATOR",
        "authorized_official_telephone_number": "850-878-5310",
        "authorized_official_credential": "MSW"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "FL",
            "license": "5002096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "087524400",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "087524401",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "U15",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Big Bend Cares Inc (Care Point Health & Wellness Pharmacy)
• Big Bend Center for Human Service
• Big Bend Chiropractic LLC
• Big Bend Communtiy Based Care
• Big Bend Hospice, Inc.
• Big Bend Infusion LLC (Vital Care of Tallahassee)
• Big Bend Net LLC
• Big Bend Net LLC
• Big Bend Transit, Inc.
• Big Bend Transit, Inc.

• Community Based Hospice Care Agency in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Community Based Hospice Care Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 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.