North Gwinnett Hospice Services, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

NORTH GWINNETT HOSPICE SERVICES, LLC

Practice address

530 Highland Station Dr Ste 3002
Suwanee, GA 30024-6576

Phone

(404) 390-5587

Fax

(929) 564-8690

NPI assigned

May 22, 2024

Last updated

May 22, 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

Ben Udo

Title

Owner/President

Phone

(404) 390-5587

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508605379. Details of each certification follow.

• CCN 851602 Hospice · Active · Details

Hospice certification: CCN 851602

Legal name

NORTH GWINNETT HOSPICE SERVICES LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Dec 30, 2024

Last certification

Dec 30, 2024

Ownership / control type

Proprietary - Individual

Organization structure

LLCProprietary

Incorporated

Feb 15, 2024 in GA

Enrollment address

530 Highland Station Dr
Ste 3002
Suwanee, GA 30024-6576

Listed as

North Gwinnett Hospice Services, LLCCCN 851602 · All quality measures

Certified

Dec 30, 2024

Medicare certification status

ActiveFrom the Provider of Services file

All disclosed owners & managing parties 2

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.

• Emem Udo, MD

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1801073465

  Corporate Officer, W-2 Managing Employee

  CMS ownership

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.

• Emem Udo, MD

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1801073465
  Medicare reassignment NPD

Affiliated clinicians 1

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

• Emem Udo, MD

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1801073465

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1716336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716336000000",
    "number": "1508605379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 HIGHLAND STATION DR STE 3002",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300246576",
            "telephone_number": "404-390-5587",
            "fax_number": "929-564-8690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 HIGHLAND STATION DR STE 3002",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300246576",
            "telephone_number": "404-390-5587",
            "fax_number": "929-564-8690"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH GWINNETT HOSPICE SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-22",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "status": "A",
        "authorized_official_last_name": "UDO",
        "authorized_official_first_name": "BEN",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "404-390-5587"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Community Based Hospice Care Agency in Suwanee, GA
• Providers in Suwanee, GA by specialty
• Community Based Hospice Care Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 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.