Axiom Hospice LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

AXIOM HOSPICE LLC

Practice address

12815 Northline Rd
Southgate, MI 48195-1109

Phone

(734) 324-3166

Fax

(866) 422-4071

NPI assigned

Jan 12, 2023

Organization subpart

No

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

Authorized official

Name

Imran A Khan

Title

Owner

Phone

(734) 324-3166

Specialties & licenses 1

Addresses

Other names 1

• Axiom Hospice Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Hospice certification: CCN 231717

Legal name

AXIOM HOSPICE LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Dec 4, 2023

Last certification

Nov 30, 2023

Organization structure

LLCProprietary

Incorporated

Jan 12, 2023 in MI

Enrollment address

12815 Northline Rd
Southgate, MI 48195-1109

Listed as

Axiom Hospice, LLCCCN 231717

Certified

Dec 4, 2023

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 1

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

Affiliated clinicians 1

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

• Navin Raj, M.D.

  • Family Medicine Physician
  • Canton, MI
  • NPI 1033421706

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1673481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673481600000",
    "number": "1659085744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12815 NORTHLINE RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481951109",
            "telephone_number": "734-324-3166",
            "fax_number": "866-422-4071"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12815 NORTHLINE RD",
            "city": "SOUTHGATE",
            "state": "MI",
            "postal_code": "481951109",
            "telephone_number": "734-324-3166",
            "fax_number": "866-422-4071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AXIOM HOSPICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-12",
        "last_updated": "2023-01-12",
        "certification_date": "2023-01-12",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "IMRAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "734-324-3166"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Axiom Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ghassan Amir Atto, MD
• Nathan Aubert
• Cheyenne Taylor Lynn Austin, LLBSW
• Tracy Lynette Austin, LLMSW, SST
• Eduardo Avena
• Emmanuel Ayala
• Gladys Marie Ayala, M.T
• Elzbieta Wieslawa Baba, DNP
• Erika Bacha
• Michelle M Backus-Porter

• Community Based Hospice Care Agency in Southgate, MI
• Providers in Southgate, MI by specialty
• Community Based Hospice Care Agency in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 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.

Verify at the official NPI Registry.