Shalom House Inc #2

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

SHALOM HOUSE INC #2

Doing business as

Shalom Hospice

Practice address

13905 E 39TH St S Ste 104
Independence, MO 64055-3378

Phone

(816) 272-8181

Fax

(816) 256-4182

NPI assigned

Feb 16, 2015

Organization subpart

No

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

Authorized official

Name

Norma L Poindexter, RN

Title

Owner

Phone

(404) 630-3520

Specialties & licenses 1

Addresses

Other names 1

• Shalom Hospice Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Hospice certification: CCN 261664

Legal name

SHALOM HOUSE INC. 2

Doing business as

SHALOM HOSPICE

Certification status

Active

Provider type (POS)

Hospice

Participating since

Mar 11, 2016

Last certification

Jul 14, 2022

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationNon-profit

Incorporated

Jan 13, 2014 in MO

Enrollment address

13905 E 39TH St S
Ste 104
Independence, MO 64055-6528

Listed as

Shalom HospiceCCN 261664 · All quality measures

Ownership

Other

Certified

Mar 11, 2016

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 6

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 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Jared J Dirks, MD

  • Family Medicine Physician
  • Kansas City, MO
  • NPI 1659351013

  Corporate Director

  CMS ownership
• Nelson Edwin Johnson, MD

  • Obstetrics & Gynecology Physician
  • Kansas City, MO
  • NPI 1508849118

  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.

• Marquita Davis

  • Community Based Hospice Care Agency
  • Independence, MO
  • NPI 1891470753

  Hospice Care, Community Based

  NPD

Affiliated clinicians 1

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

• Jared J Dirks, MD

  • Family Medicine Physician
  • Kansas City, MO
  • NPI 1659351013

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1424044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438560000000",
    "number": "1669863486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13905 E 39TH ST S STE 104",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640553378",
            "telephone_number": "816-272-8181",
            "fax_number": "660-256-4182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13905 E 39TH ST S STE 104",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640553378",
            "telephone_number": "816-272-8181",
            "fax_number": "816-256-4182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHALOM HOUSE INC #2",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-16",
        "last_updated": "2015-08-03",
        "status": "A",
        "authorized_official_last_name": "POINDEXTER",
        "authorized_official_first_name": "NORMA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-630-3520",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shalom Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pankti Shah, D.O
• Muhammad Salman Shahid
• Mohammed Ashwaq Hussain Shaik
• Ghazal Abbas Shaikh, M.D.
• Shalom Hospice Missouri
• Amanda Shapley, LMT
• Aaron Sharky, D.D.S.
• Kimberlee Ann Sheahon, DPT
• James Gilbert Sheffer III, D.C.
• Charleen Brianne Shelley, FNP-C

• Community Based Hospice Care Agency in Independence, MO
• Providers in Independence, MO by specialty
• Community Based Hospice Care Agency in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2015; 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.