NPIMap

Organization Active NPI

Kingfisher Health LLC

  • Community Based Hospice Care Agency
  • San Marcos, TX
National Provider Identifier
1609427046
Registry record updated Sep 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
KINGFISHER HEALTH LLC
Practice address
125 W McCarty LN
San Marcos, TX 78666-6416
Phone
(512) 815-9009
NPI assigned
Sep 26, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2019

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

Authorized official

Name
Hayley Hughes
Title
Administrator
Phone
(512) 694-2056

Specialties & licenses 1

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

Addresses

Primary practice location

125 W McCarty LN
San Marcos, TX 78666-6416

Mailing address

125 W McCarty LN
San Marcos, TX 78666-6416
Phone (512) 815-9009

Other names 1

  • Halcyon Home Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200402002289 TX Part A Provider - Hospice 6709128028 Practice locations: San Marcos, TX; Houston, TX

Hospice certification: CCN 971605

Legal name
KINGFISHER HEALTH LLC
Doing business as
HALCYON HOME
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jul 16, 2020
Last certification
Jul 16, 2020
Ownership / control type
Proprietary - Other
Organization structure
LLCProprietary
Incorporated
Oct 18, 2018 in TX
Enrollment address
125 W McCarty LN
Suite 200
San Marcos, TX 78666-6416

Other NPIs with the same Medicare PAC ID 1

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Halcyon HomeCCN 971605
Ownership
For-Profit
Certified
Jul 16, 2020
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Halcyon Home2 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.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1400 Broadfield Blvd
Ste 102
Houston, TX 77084
Phone (281) 886-7962

125 E McCarty LN
San Marcos, TX 78666
Phone (512) 667-6775

125 W McCarty Ln
Ste 200
San Marcos, TX 78666
Phone (512) 815-9009

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
Scott K Fichter Individual Corporate OfficerBoard Member Feb 11, 2019
Amy E Sweet Individual 5% Or Greater Indirect Ownership InterestChief Executive Officer Feb 11, 2019 100%
Corporate OfficerManager, President, Vice President, Feb 11, 2019 100%
OtherManager, President, VP, Treasurer Feb 11, 2019
Ara Marie Webb Individual Corporate OfficerChief Financial Officer Feb 14, 2023
Kingfisher Health Holdings LLC Organization, Austin, TX LLC 5% Or Greater Direct Ownership Interest Nov 1, 2019 100%
Primo Abel Mayhua Individual W-2 Managing EmployeeMD; Aug 3, 2022
Tanya Louise Roberts Individual Corporate OfficerChief Administrative Officer Feb 16, 2026
W-2 Managing EmployeeAd; Feb 11, 2019
Halcyon Home LLC Organization, Austin, TX LLC, For-profit 5% Or Greater Indirect Ownership Interest Nov 1, 2019 100%

Owners & managing parties with NPI records 3

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

Facilities with the same owner 4

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.

Affiliated clinicians 4

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": "1569456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1569456000000",
    "number": "1609427046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 W MCCARTY LN",
            "city": "SAN MARCOS",
            "state": "TX",
            "postal_code": "786666416",
            "telephone_number": "512-815-9009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 W MCCARTY LN",
            "city": "SAN MARCOS",
            "state": "TX",
            "postal_code": "786666416",
            "telephone_number": "512-815-9009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGFISHER HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-26",
        "last_updated": "2019-09-26",
        "status": "A",
        "authorized_official_last_name": "HUGHES",
        "authorized_official_first_name": "HAYLEY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "512-694-2056"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Halcyon Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Marcos, TX

Sources for this page

Verify at the official NPI Registry.