NPIMap

Organization Active NPI

Prime Home Health, LLC

  • Home Health Agency
  • San Antonio, TX
National Provider Identifier
1649813874
Registry record updated Aug 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
PRIME HOME HEALTH, LLC
Practice address
4400 S Piedras Dr Ste 219
San Antonio, TX 78228-1223
Phone
(210) 251-4973
Fax
(210) 251-4467
NPI assigned
Oct 21, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2021

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

Authorized official

Name
Ivan Vargas
Title
Administrator
Phone
(210) 251-4973

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

4400 S Piedras Dr Ste 219
San Antonio, TX 78228-1223

Mailing address

4400 S Piedras Dr Ste 219
San Antonio, TX 78228-1223
Phone (210) 251-4973

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200130002954 TX Part A Provider - Home Health Agency 7719313287 Practice locations: San Antonio, TX

Home health agency certification: CCN 453194

Legal name
PRIME HOME HEALTH LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Nov 18, 2004
Last certification
Mar 6, 2019
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Enrollment address
7800 W Ih 10
Ste 100
San Antonio, TX 78230-4768

Care Compare: Home health agency

Medicare Care Compare
Listed as
Prime Home Health, LLCCCN 453194
Overall star rating
4 of 5
Ownership
Proprietary
Certified
Nov 18, 2004
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2206769Prime Home Health LLC7800 W Ih-10 Suite 100, San Antonio, TX 78230Certificate of waiverDec 21, 2026

National Provider Directory

National Provider Directory

Locations

506 E Ramsey Rd
Ste 1
San Antonio, TX 78216
Phone (210) 251-4973

Ownership & related parties

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.

NameRoleSinceShare
Ivan Vargas Individual W-2 Managing EmployeeAd; Aug 7, 2019 25%
Toque Holdings LLC Organization, San Antonio, TX Holding company 5% Or Greater Indirect Ownership Interest Dec 9, 2024
Rye Holdings LLC Organization, San Antonio, TX Holding company 5% Or Greater Indirect Ownership Interest Dec 9, 2024
Nicole Michel Individual Operational/Managerial ControlAlternate Director of Nurses Dec 1, 2025 25%
Primehhc Holdings, LLC Organization, San Antonio, TX Holding company, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Dec 9, 2024 100%
Hhcmeri LLC Organization, Porter Ranch, CA Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 9, 2024 50%
Meri Markosyan Individual 5% Or Greater Indirect Ownership InterestOwner Dec 9, 2024 100%
Corporate DirectorGoverning Body Member Dec 9, 2024 50%
Kristi Jacobs Individual 5% Or Greater Indirect Ownership InterestOwner Jul 26, 2024 100%
Corporate DirectorGoverning Body Member Dec 9, 2024 50%
Isabella Lichtenberger Individual W-2 Managing EmployeeAd; Nov 7, 2019 25%
Operational/Managerial ControlDirector of Nurses Nov 9, 2019 25%

Change-of-ownership history 1

DateEventCounterparty
Aug 7, 2019 Change of OwnershipThis provider was the buyer Maxmed Healthcare, IncCCN 453194, TX, NPI 1497895171

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

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 42

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

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1571616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628121600000",
    "number": "1649813874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 S PIEDRAS DR STE 219",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782281223",
            "telephone_number": "210-251-4973",
            "fax_number": "210-251-4467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4400 S PIEDRAS DR STE 219",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782281223",
            "telephone_number": "210-251-4973",
            "fax_number": "210-251-4467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HOME HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-21",
        "last_updated": "2021-08-05",
        "certification_date": "2021-05-07",
        "status": "A",
        "authorized_official_last_name": "VARGAS",
        "authorized_official_first_name": "IVAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "210-251-4973"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.