Active NPI
Good Shepherd Homecare & Hospice Inc
- Community Based Hospice Care Agency
- Manhattan, KS
National Provider Identifier
1609852979
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- License
- A081002
- Legal business name
- GOOD SHEPHERD HOMECARE & HOSPICE INC
- Practice address
- 3801 Vanesta Dr
Manhattan, KS 66503-0316 - Phone
- (785) 537-0688
- Fax
- (785) 537-1309
- NPI assigned
- Dec 19, 2005
- Last updated
- Apr 7, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Christina J Nolte
- Title
- Executive Director
- Phone
- (785) 537-0688
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | A081002 | KS | Primary |
Addresses
Primary practice location
3801 Vanesta Dr
Manhattan, KS 66503-0316
Mailing address
3801 Vanesta Dr
Manhattan, KS 66503-0316
Phone (178) 553-7068
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100221180B | Medicaid | KS | |
| 834 | Other | KS | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KS
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050131000714 | KS | Part A Provider - Hospice | 4981654597 | Practice locations: Manhattan, KS |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1609852979. Details of each certification follow.
Hospice certification: CCN 171517
- Legal name
- GOOD SHEPHERD HOMECARE & HOSPICE, INC.
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Dec 10, 1992
- Last certification
- Jul 12, 2018
- Ownership / control type
- Proprietary - Corporation
- Organization structure
- Corporation
- Incorporated
- Aug 4, 1978 in KS
- Enrollment address
- 3801 Vanesta Dr
Manhattan, KS 66503-0316
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
- Good Shepherd Homecare & Hospice Inc
- Ownership
- For-Profit
- Certified
- Dec 10, 1992
- Medicare certification status
- Active
National Provider Directory
National Provider Directory- Tax ID family
- Good Shepherd Homecare Hospice Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Home Health Agency
- Manhattan, KS
- NPI 1285610139
Locations
3801 Vanesta Dr
Manhattan, KS 66503
Phone (785) 537-0688
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.
| Name | Role | Since | Share |
|---|---|---|---|
| Dan Crouch | Corporate Officer | Oct 1, 2020 | |
| Devin Wendt | Corporate Officer | Oct 1, 2020 | |
| Brooke Disney | W-2 Managing Employee | Dec 28, 2021 | |
| Todd Chyba | Corporate Officer | Oct 1, 2017 | |
| Christina J Nolte | Corporate Director | Dec 8, 2016 |
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.
-
- Otolaryngology Physician
- Manhattan, KS
- NPI 1053398339
Affiliated clinicians 17
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": "1134950400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1680825600000",
"number": "1609852979",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3801 VANESTA DR",
"city": "MANHATTAN",
"state": "KS",
"postal_code": "665030316",
"telephone_number": "178-553-7068",
"fax_number": "785-537-1309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3801 VANESTA DR",
"city": "MANHATTAN",
"state": "KS",
"postal_code": "665030316",
"telephone_number": "785-537-0688",
"fax_number": "785-537-1309"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GOOD SHEPHERD HOMECARE & HOSPICE INC",
"organizational_subpart": "NO",
"enumeration_date": "2005-12-19",
"last_updated": "2023-04-07",
"certification_date": "2023-04-07",
"status": "A",
"authorized_official_last_name": "NOLTE",
"authorized_official_first_name": "CHRISTINA",
"authorized_official_middle_name": "J",
"authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
"authorized_official_telephone_number": "785-537-0688"
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": "KS",
"license": "A081002",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100221180B",
"state": "KS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "834",
"state": "KS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Manhattan, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2023; 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.