Premium Select Home Care Inc

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

097050 Issued in DC

Legal business name

PREMIUM SELECT HOME CARE INC

Practice address

5513 Illinois Ave NW
Washington, DC 20011-2937

Phone

(202) 882-9310

Fax

(202) 882-9374

NPI assigned

Mar 6, 2007

Last updated

Mar 5, 2020By 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

Mrs. Linda Hart Davis, R.N., M.S.

Title

Administrator

Phone

(202) 882-9310

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437289840. Details of each certification follow.

• CCN 097050 Home health agency · Active · Details

Home health agency certification: CCN 097050

Legal name

PREMIUM SELECT HOME CARE INC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Sep 22, 2000

Last certification

Nov 30, 2018

Ownership / control type

Proprietary

Organization structure

CorporationProprietary

Incorporated

Jul 24, 1996 in DC

Enrollment address

5513 Illinois Ave NW
Washington, DC 20011-2937

Listed as

Premium Select Home Care, IncCCN 097050 · All quality measures

Ownership

Proprietary

Certified

Sep 22, 2000

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Locations

All disclosed owners & managing parties 6

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 1

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

• James Louis Davis, M.D.

  • Infectious Disease Physician
  • Washington, DC
  • NPI 1376679456

  5% Or Greater Direct Ownership Interest, Corporate Director, W-2 Managing Employee

  CMS ownership

Practitioners 152

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.

• Juliana Abrams

  • Home Health Aide
  • Washington, DC
  • NPI 1427318583
  NPD (past)
• Robin Abrams

  • Home Health Aide
  • Washington, DC
  • NPI 1922368083
  NPD (past)
• Barbara Addo

  • Home Health Aide
  • Washington, DC
  • NPI 1427318484
  NPD (past)
• Bayonle N Adegbola

  • Home Health Aide
  • Washington, DC
  • NPI 1023378700
  NPD (past)
• Olusola Adeyemi

  • Home Health Aide
  • Washington, DC
  • NPI 1467045336
  NPD (past)
• Evette Adiet

  • Case Manager/Care Coordinator
  • Washington, DC
  • NPI 1578231668
  NPD (past)
• Nana Amma Adu

  • Home Health Aide
  • Washington, DC
  • NPI 1841874187
  NPD (past)
• Bodunrin Samuel Agbaosi

  • Home Health Aide
  • Washington, DC
  • NPI 1700146677
  NPD (past)
• Abisola Ajibike

  • Home Health Aide
  • Washington, DC
  • NPI 1932794971
  NPD (past)
• Madhavan Inche Akande

  • Case Manager/Care Coordinator
  • Washington, DC
  • NPI 1932742715
  NPD (past)
• Simon Nkwelle Akande

  • Home Health Aide
  • Washington, DC
  • NPI 1750923116
  NPD (past)
• Boluwatife Ayomide Akano

  • Home Health Aide
  • Washington, DC
  • NPI 1770325284
  NPD (past)

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583366400000",
    "number": "1437289840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5513 ILLINOIS AVE NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200112937",
            "telephone_number": "202-882-9310",
            "fax_number": "202-882-9374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5513 ILLINOIS AVE NW",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "200112937",
            "telephone_number": "202-882-9310",
            "fax_number": "202-882-9374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM SELECT HOME CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-06",
        "last_updated": "2020-03-05",
        "certification_date": "2020-03-05",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "HART",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "202-882-9310",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.N., M.S."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "DC",
            "license": "097050",
            "primary": true
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "026854200",
            "state": "DC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "026852600",
            "state": "DC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Premier Pediatrics LLC
• Premier Support Services Inc
• Demetria Angela-Taylor Premier, MSW
• Premiere Ortho-Pedo PLLC
• Premium Select
• John Prempeh, MD
• Mladen Premuzic, MD
• Yinette Denia Prendas
• Denise Marie Prendergast, LCSW
• Prentice, PLLC

• Home Health Agency in Washington, DC
• Providers in Washington, DC by specialty
• Home Health Agency in District of Columbia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2020; 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.