Organization Active NPI

Serenity Healthcare Services LLC

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • Ballwin, MO
National Provider Identifier
1427823798
Registry record updated Nov 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Internal Medicine) PhysicianTaxonomy code 207RH0002X
Legal business name
SERENITY HEALTHCARE SERVICES LLC
Practice address
301 Sovereign CT Ste 209
Ballwin, MO 63011-4435
Phone
(314) 833-3180
NPI assigned
Nov 16, 2023
Last updated
Nov 16, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2023

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

Authorized official

Name
Yosef Manne
Title
Member
Phone
(314) 833-3180

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Nurse Practitioner 363LC0200X NU
Hospice and Palliative Medicine (Emergency Medicine) Physician 207PH0002X NU
Hospice and Palliative Medicine (Internal Medicine) Physician 207RH0002X NU Primary
Hospice and Palliative Medicine (Physical Medicine & Rehabilitation) Physician 2081H0002X NU

Addresses

Primary practice location

301 Sovereign CT Ste 209
Ballwin, MO 63011-4435

Mailing address

301 Sovereign CT Ste 209
Ballwin, MO 63011-4435
Phone (314) 833-3180

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240208000276 MO Part B Supplier - Clinic/Group Practice 9234572165 Receives reassigned benefits from 2 practitioners
Practice locations: Ballwin, MO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1700092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700092800000",
    "number": "1427823798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 SOVEREIGN CT STE 209",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630114435",
            "telephone_number": "314-833-3180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 SOVEREIGN CT STE 209",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630114435",
            "telephone_number": "314-833-3180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERENITY HEALTHCARE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-16",
        "last_updated": "2023-11-16",
        "certification_date": "2023-11-16",
        "status": "A",
        "authorized_official_last_name": "MANNE",
        "authorized_official_first_name": "YOSEF",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "314-833-3180"
    },
    "taxonomies": [
        {
            "code": "363LC0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Critical Care Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207PH0002X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Hospice and Palliative Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2081H0002X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Hospice and Palliative Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ballwin, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.