Hospice of Jackson County,Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

HOSPICE OF JACKSON COUNTY,INC

Practice address

611 W Quarry St
Maquoketa, IA 52060-2125

Phone

(563) 652-0123

Fax

(563) 652-2181

NPI assigned

Jul 5, 2005

Last updated

Dec 13, 2022By 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

Rae Ann Thede

Title

Director

Phone

(563) 652-0123

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609873769. Details of each certification follow.

• CCN 161569 Hospice · Active · Details

Hospice certification: CCN 161569

Legal name

HOSPICE OF JACKSON COUNTY,INC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Sep 12, 2003

Last certification

Sep 8, 2020

Ownership / control type

Non-Profit - Private

Organization structure

CorporationNon-profit

Incorporated

Nov 18, 2001 in IA

Enrollment address

611 W Quarry St
Maquoketa, IA 52060-2125

Listed as

Hospice of Jackson CountyCCN 161569 · All quality measures

Ownership

Non-Profit

Certified

Sep 12, 2003

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

Locations

All disclosed owners & managing parties 9

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.

• Bradley B Waller, MD

  • Family Medicine Physician
  • Maquoketa, IA
  • NPI 1609433796

  Contracted Managing Employee, Corporate Director

  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.

• Pedro Olap Atienza, M.D.

  • Surgery Physician
  • Maquoketa, IA
  • NPI 1912977620
  NPD (past)

Affiliated clinicians 7

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

• Jerald W Bybee, MD

  • Family Medicine Physician
  • Maquoketa, IA
  • NPI 1659360816

  Hospice

  Care Compare affiliation
• Jeffrey Michael Hunter, M.D.

  • Family Medicine Physician
  • Bellevue, IA
  • NPI 1023125796

  Hospice

  Care Compare affiliation
• Eric Scott Petersen, D.O.

  • Family Medicine Physician
  • Maquoketa, IA
  • NPI 1538149042

  Hospice

  Care Compare affiliation
• Brandon Beau Rickertsen, D.O.

  • Family Medicine Physician
  • Maquoketa, IA
  • NPI 1639519531

  Hospice

  Care Compare affiliation
• Kimberly A Thompson, DO

  • Family Medicine Physician
  • Maquoketa, IA
  • NPI 1942252895

  Hospice

  Care Compare affiliation
• Bradley B Waller, MD

  • Family Medicine Physician
  • Maquoketa, IA
  • NPI 1609433796

  Hospice

  Care Compare affiliation
• Roger R Waller, MD

  • Family Medicine Physician
  • Maquoketa, IA
  • NPI 1750370011

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1120521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670889600000",
    "number": "1609873769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 675",
            "address_2": "611 WEST QUARRY STREET",
            "city": "MAQUOKETA",
            "state": "IA",
            "postal_code": "520602125",
            "telephone_number": "563-652-0123",
            "fax_number": "563-652-2181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 W QUARRY ST",
            "city": "MAQUOKETA",
            "state": "IA",
            "postal_code": "520602125",
            "telephone_number": "563-652-0123",
            "fax_number": "563-652-2181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPICE OF JACKSON COUNTY,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-05",
        "last_updated": "2022-12-13",
        "certification_date": "2022-12-13",
        "status": "A",
        "authorized_official_last_name": "THEDE",
        "authorized_official_first_name": "RAE",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "563-652-0123"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0615765",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heinrich Chiropractic PLLC
• Hillcrest Family Services
• Hillcrest Family Services
• Horst Chiropractic PC
• Paul Richard Horst, D.C.
• Jill M Hunt, M.D.
• Jessica A Ihns, PSY.D.
• Jackson County Case Management
• Jackson County Public Hospital (Jackson County Regional Health Center)
• Jackson County Public Hospital (Jackson County Regional Health Center)

• Community Based Hospice Care Agency in Maquoketa, IA
• Providers in Maquoketa, IA by specialty
• Community Based Hospice Care Agency in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2022; 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.