In My Home Hospice Care

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

IN MY HOME HOSPICE CARE

Practice address

1204 E Baseline Rd Ste 101
Tempe, AZ 85283-1447

Phone

(480) 590-6556

Fax

(888) 524-5507

NPI assigned

Oct 23, 2020

Last updated

Oct 23, 2020By 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

Gary Davis

Title

Owner

Phone

(602) 319-5223

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629677224. Details of each certification follow.

• CCN 031748 Hospice · Active · Details

Hospice certification: CCN 031748

Legal name

IN MY HOME HOSPICE CARE

Certification status

Active

Provider type (POS)

Hospice

Participating since

Apr 17, 2021

Last certification

Apr 17, 2021

Ownership / control type

Proprietary - Individual

Organization structure

LLCProprietary

Enrollment address

1204 E Baseline Rd
Ste 101
Tempe, AZ 85283-1447

Listed as

In My Home Hospice CareCCN 031748 · All quality measures

Ownership

For-Profit

Certified

Apr 17, 2021

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

All disclosed owners & managing parties 2

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

Affiliated clinicians 2

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

• Richard Kim Le, D.O

  • Family Medicine Physician
  • Chandler, AZ
  • NPI 1851393003

  Hospice

  Care Compare affiliation
• Gregory J Opdahl, MD

  • Anesthesiology Physician
  • Tillamook, OR
  • NPI 1194985788

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1603411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603411200000",
    "number": "1629677224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 E BASELINE RD STE 101",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852831447",
            "telephone_number": "480-590-6556",
            "fax_number": "888-524-5507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1204 E BASELINE RD STE 101",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852831447",
            "telephone_number": "480-590-6556",
            "fax_number": "888-524-5507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IN MY HOME HOSPICE CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-23",
        "last_updated": "2020-10-23",
        "certification_date": "2020-10-23",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "602-319-5223"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Illium, ATC
• Im Specialist, Inc
• Iman Transport LLC
• Mara Danielle Immediato, PA-C
• Michael Francis Imperato
• In Power Trans LLC
• In Pulse Chiropractic PC (David M. Israel DC)
• David Jacob Incardona, PHARMD
• Indigenous Health LLC (Indigenous Health)
• Infant Child Research Program

• Community Based Hospice Care Agency in Tempe, AZ
• Providers in Tempe, AZ by specialty
• Community Based Hospice Care Agency in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2020; 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.