Country Care Hospice, Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

COUNTRY CARE HOSPICE, INC

Practice address

104 N Steen St
Mount Hope, KS 67108-9305

Phone

(316) 661-5917

NPI assigned

Apr 27, 2021

Last updated

Apr 27, 2021By 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

Teresa Achilles

Title

Owner

Phone

(316) 259-7633

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417539610. Details of each certification follow.

• CCN 171615 Hospice · Active · Details

Hospice certification: CCN 171615

Legal name

COUNTRY CARE HOSPICE, INC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Nov 15, 2021

Last certification

Nov 15, 2021

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationNon-profit

Incorporated

Mar 5, 2021 in KS

Enrollment address

710 W 14TH Ave
Harper, KS 67058-0306

Listed as

Country Care Hospice, IncCCN 171615 · All quality measures

Ownership

For-Profit

Certified

Nov 15, 2021

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 5

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

Affiliated clinicians 3

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

• Hope Elizabeth Hewitt, NP

  • Nurse Practitioner
  • Medicine Lodge, KS
  • NPI 1134657158

  Hospice

  Care Compare affiliation
• Nizar D Kibar, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Anthony, KS
  • NPI 1124096300

  Hospice

  Care Compare affiliation
• Ethan Myles Leavitt, D.O.

  • Family Medicine Physician
  • Anthony, KS
  • NPI 1780995746

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1619481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619481600000",
    "number": "1417539610",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 N STEEN ST",
            "city": "MOUNT HOPE",
            "state": "KS",
            "postal_code": "671089305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 N STEEN ST",
            "city": "MOUNT HOPE",
            "state": "KS",
            "postal_code": "671089305",
            "telephone_number": "316-661-5917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY CARE HOSPICE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-27",
        "last_updated": "2021-04-27",
        "certification_date": "2021-04-27",
        "status": "A",
        "authorized_official_last_name": "ACHILLES",
        "authorized_official_first_name": "TERESA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "316-259-7633"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Crystal Kay Ernst
• Evelyn Febo, PTA
• Katie L. Neidig DDS, LLC
• Joanie Koehler, RPT
• Mount Hope Community Ambulance Service, Inc

• Community Based Hospice Care Agency in Mount Hope, KS
• Providers in Mount Hope, KS by specialty
• Community Based Hospice Care Agency in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2021; 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.