Sholom Community Alliance Home Health Care

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

SHOLOM COMMUNITY ALLIANCE HOME HEALTH CARE

Doing business as

Sholom Hospice

Practice address

3630 Phillips Pkwy
St Louis Park, MN 55426-3792

Phone

(952) 939-1515

Fax

(952) 933-1485

NPI assigned

Jun 2, 2008

Organization subpart

No

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

Authorized official

Name

Douglas Wyckoff

Title

Controller

Phone

(952) 939-1637

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Sholom Hospice Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Hospice certification: CCN 241585

Legal name

SHOLOM COMMUNITY ALLIANCE HOME HEALTH CARE

Doing business as

SHOLOM HOSPICE, JOHNSON HOSPICE CARE AGENCY

Certification status

Active

Provider type (POS)

Hospice

Participating since

May 8, 2009

Last certification

May 9, 2019

Ownership / control type

Other

Organization structure

CorporationNon-profit

Incorporated

Nov 1, 2001 in MN

Enrollment address

3620 Phillips Pkwy
St Louis Park, MN 55426-3700

Other NPIs with the same Medicare PAC ID 1

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

• Sholom Community Alliance Home Health Care

  • Home Health Agency
  • St Louis Park, MN
  • NPI 1386914588

  7810061447

  Same PAC ID

Listed as

Sholom HospiceCCN 241585 · All quality measures

Ownership

Non-Profit

Certified

May 8, 2009

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

Sholom Community Alliance Home Health Care3 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.

• Sholom Community Alliance Home Health Care

  • Home Health Agency
  • St Louis Park, MN
  • NPI 1295704005
  NPD tax ID
• Sholom Community Alliance Home Health Care

  • Home Health Agency
  • St Louis Park, MN
  • NPI 1386914588
  NPD tax ID

Locations

All disclosed owners & managing parties 22

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

Affiliated clinicians 4

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

• Christine Duncan, M.D.

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1497730931

  Hospice

  Care Compare affiliation
• Elina Lipovskiy, D.O.

  • Family Medicine Physician
  • St Louis Park, MN
  • NPI 1538540109

  Hospice

  Care Compare affiliation
• Sarah C Maier, MD

  • Family Medicine Physician
  • Minneapolis, MN
  • NPI 1710953427

  Hospice

  Care Compare affiliation
• Himanshu S Sharma, MD

  • Family Medicine Physician
  • Saint Paul, MN
  • NPI 1720040900

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1212364800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557792000000",
    "number": "1558529941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3630 PHILLIPS PKWY",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554263792",
            "telephone_number": "952-939-1515",
            "fax_number": "952-933-1485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3630 PHILLIPS PKWY",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554263792",
            "telephone_number": "952-939-1515",
            "fax_number": "952-933-1485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOLOM COMMUNITY ALLIANCE HOME HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-02",
        "last_updated": "2019-05-14",
        "status": "A",
        "authorized_official_last_name": "WYCKOFF",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "952-939-1637"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "271243100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sholom Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sholom Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jacob Shimpa, PHARM D
• Margaret Mary Shipitalo, OD, MS
• Omri Shochatovitz
• Sholom Community Alliance Home Health Care
• Sholom Community Alliance Home Health Care
• Sholom Community Alliance, LLC
• Sholom Home West Inc
• Joan Marie Shopbell, RD
• Benjamin Shoults
• Sidney G Showers

• Community Based Hospice Care Agency in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Community Based Hospice Care Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2019; 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.