Good Shepherd Hospice of Mid-America Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

1243H0 Issued in MO

Legal business name

GOOD SHEPHERD HOSPICE OF MID-AMERICA INC

Practice address

123 W Kansas Ave
Independence, MO 64050-3732

Phone

(816) 822-2292

Fax

(816) 822-2298

NPI assigned

Sep 1, 2006

Last updated

Oct 2, 2024By 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

Mr. Jason Kyle Delester

Title

President

Phone

(405) 943-0903

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497857551. Details of each certification follow.

• CCN 261595 Hospice · Active · Details

Hospice certification: CCN 261595

Legal name

GOOD SHEPHERD HOSPICE OF MID-AMERICA INC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Aug 22, 2003

Last certification

Dec 5, 2018

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Apr 24, 2001 in OK

Enrollment address

123 W Kansas Ave
Independence, MO 64050-3732

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Good Shepherd Hospice of Mid-America Inc

  • Community Based Hospice Care Agency
  • Olathe, KS
  • NPI 1700104718

  1850209214

  Same PAC ID

Listed as

Good Shepherd Hospice of Mid-America, Inc.CCN 261595 · All quality measures

Ownership

For-Profit

Certified

Aug 22, 2003

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

Tax ID family

Ability Network2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Good Shepherd Hospice of Mid-America Inc

  • Community Based Hospice Care Agency
  • Olathe, KS
  • NPI 1700104718
  NPD tax ID

Locations

All disclosed owners & managing parties 8

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.

• Scott F. Avery, D.O.

  • Family Medicine Physician
  • Junction City, KS
  • NPI 1427230069

  Contracted Managing Employee

  CMS ownership

Affiliated clinicians 3

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

• Amie Lynn Etters, MD

  • Family Medicine Physician
  • Windsor, MO
  • NPI 1750309514

  Hospice

  Care Compare affiliation
• Sarah Nicole Kirchhoff, MD

  • Family Medicine Physician
  • Concordia, MO
  • NPI 1629459045

  Hospice

  Care Compare affiliation
• Scott F. Avery, D.O.

  • Family Medicine Physician
  • Junction City, KS
  • NPI 1427230069

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727827200000",
    "number": "1497857551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 W KANSAS AVE",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640503732",
            "telephone_number": "816-822-2292",
            "fax_number": "816-822-2298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 W KANSAS AVE",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640503732",
            "telephone_number": "816-822-2292",
            "fax_number": "816-822-2298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SHEPHERD HOSPICE OF MID-AMERICA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-01",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A",
        "authorized_official_last_name": "DELESTER",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "KYLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "405-943-0903",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MO",
            "license": "1243H0",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "826099202",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/gateway/documentsubmission/2_0/NhinService/SDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd SteB",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Jamie Golden, CCC-SLP
• Melanie Gonzalez, DPM
• Kristen Nikole Goodrich, RN, NNP-BC
• Dana Ashlyn Goodwin, LMSW
• Megan Elyssa Goring, PTA
• Amelia Goslin, DO
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• Community Based Hospice Care Agency in Independence, MO
• Providers in Independence, MO by specialty
• Community Based Hospice Care Agency in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2024; 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.