NPIMap

Organization Active NPI

Hutto Hospice Inc.

Doing business as Divinity Hospice

  • Community Based Hospice Care Agency
  • Round Rock, TX
National Provider Identifier
1447955893
Registry record updated Apr 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
HUTTO HOSPICE INC.
Doing business as
Divinity Hospice
Practice address
3000 Joe Dimaggio Blvd Ste 40
Round Rock, TX 78665-3995
Phone
(512) 337-8690
Fax
(512) 942-5237
NPI assigned
Apr 4, 2023
Last updated
Apr 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2023

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

Authorized official

Name
Jason Campbell
Title
VP of Operations
Phone
(713) 550-2547

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

3000 Joe Dimaggio Blvd Ste 40
Round Rock, TX 78665-3995

Mailing address

3000 Joe Dimaggio Blvd Ste 40
Round Rock, TX 78665-3995
Phone (512) 337-8690

Other names 1

  • Divinity Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231030000518 TX Part A Provider - Hospice 2961858840 Practice locations: Round Rock, TX

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447955893. Details of each certification follow.

Hospice certification: CCN A91717

Legal name
HUTTO HOSPICE INC.
Doing business as
DIVINITY HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jul 18, 2024
Last certification
May 31, 2024
Organization structure
CorporationProprietary
Enrollment address
3000 Joe Dimaggio Blvd
Ste 40
Round Rock, TX 78665-3995

Care Compare: Hospice

Medicare Care Compare
Listed as
Divinity HospiceCCN A91717 · All quality measures
Certified
Jul 18, 2024
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

3000 Joe Dimaggio Blvd
Ste 40
Round Rock, TX 78665
Phone (512) 337-8690

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Jason Campbell Individual 5% Or Greater Indirect Ownership Interest Aug 2, 2023 9%
Corporate OfficerVP of Operations Aug 2, 2023
W-2 Managing EmployeeAdministrator Aug 2, 2023
Michael Pena Individual 5% Or Greater Indirect Ownership Interest Aug 2, 2023 24%
Mitchell Epps Individual 5% Or Greater Direct Ownership Interest Aug 2, 2023 20%
Divinity Holdings LLC Organization, Houston, TX LLC 5% Or Greater Direct Ownership Interest Aug 2, 2023 60%
Alexander Stevens Individual 5% Or Greater Direct Ownership Interest Aug 2, 2023 20%
Diana L Stone Individual Contracted Managing EmployeeMD; Jan 1, 2025
Jay Campbell Individual 5% Or Greater Indirect Ownership Interest Aug 2, 2023 27%
Corporate OfficerPresident Aug 2, 2023

Owners & managing parties with NPI records 1

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

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": "1680566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680566400000",
    "number": "1447955893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 JOE DIMAGGIO BLVD STE 40",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786653995",
            "telephone_number": "512-337-8690",
            "fax_number": "512-942-5237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 JOE DIMAGGIO BLVD STE 40",
            "city": "ROUND ROCK",
            "state": "TX",
            "postal_code": "786653995",
            "telephone_number": "512-337-8690",
            "fax_number": "512-942-5237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HUTTO HOSPICE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-04",
        "last_updated": "2023-04-04",
        "certification_date": "2023-04-04",
        "status": "A",
        "authorized_official_last_name": "CAMPBELL",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "713-550-2547"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Divinity Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Round Rock, TX

Sources for this page

Verify at the official NPI Registry.