NPIMap

Organization Active NPI

Northland Hospice & Palliative Care Inc

  • Community Based Hospice Care Agency
  • Flagstaff, AZ
National Provider Identifier
1558328583
Registry record updated Dec 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
HSPC0007 Issued in AZ
Legal business name
NORTHLAND HOSPICE & PALLIATIVE CARE INC
Practice address
452 N. Switzer Canyon Dr.
Ste. a
Flagstaff, AZ 86001-4855
Phone
(928) 779-1227
Fax
(928) 779-5884
NPI assigned
Apr 26, 2006
Last updated
Dec 9, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2015

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

Authorized official

Name
Mrs. Patricia Bartholomew, RN MSN
Title
Executive Director
Phone
(928) 779-1227

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X HSPC0007 AZ Primary

Addresses

Primary practice location

452 N. Switzer Canyon Dr.
Ste. a
Flagstaff, AZ 86001-4855

Mailing address

P.O. Box 977
Flagstaff, AZ 83002-0997
Phone (928) 779-1227

Other identifiers 2

IdentifierTypeStateIssuer
726185MedicaidAZ
110495MedicaidAZ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040618001389 AZ Part A Provider - Hospice 7214912856 Practice locations: Flagstaff, AZ

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1558328583. Details of each certification follow.

Hospice certification: CCN 031512

Legal name
NORTHLAND HOSPICE & PALLIATIVE CARE INC
Doing business as
NORTHLAND HOSPICE AND PALLIATIVE CARE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jun 16, 1992
Last certification
Nov 8, 2019
Ownership / control type
Non-Profit - Private
Organization structure
CorporationNon-profit
Incorporated
Jun 17, 1985 in AZ
Enrollment address
452 N Switzer Canyon Dr
Ste a
Flagstaff, AZ 86001-4855

Care Compare: Hospice

Medicare Care Compare
Listed as
Northland Hospice and Palliative Care, Inc.CCN 031512 · All quality measures
Ownership
For-Profit
Certified
Jun 16, 1992
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Northland Hospice Palliative Care Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

452 N Switzer Canyon Dr
Ste A
Flagstaff, AZ 86001
Phone (928) 779-1227

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Katherine Simmons Individual Corporate DirectorCeo Jun 7, 2017 5%
W-2 Managing EmployeeCeo Jun 17, 2014 5%
Angelic Lomeli Individual Corporate OfficerBoard Vice- President Nov 19, 2018
Cindie McArthur Individual Corporate OfficerBoard President Jul 10, 2017
Twila Gleason Individual Corporate OfficerTreasure Oct 3, 2017
Katrina Renee Cuevas Individual Corporate OfficerSecretary Jan 25, 2021

Owners & managing parties with NPI records 1

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

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

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.

Affiliated clinicians 1

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

NPI Registry JSON

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449619200000",
    "number": "1558328583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 977",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "830020997",
            "telephone_number": "928-779-1227",
            "fax_number": "928-779-5884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "452 N. SWITZER CANYON DR.",
            "address_2": "STE. A",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860014855",
            "telephone_number": "928-779-1227",
            "fax_number": "928-779-5884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHLAND HOSPICE & PALLIATIVE CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-26",
        "last_updated": "2015-12-09",
        "status": "A",
        "authorized_official_last_name": "BARTHOLOMEW",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "928-779-1227",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN  MSN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "AZ",
            "license": "HSPC0007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "726185",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110495",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flagstaff, AZ

Sources for this page

Verify at the official NPI Registry.