NPIMap

Organization Active NPI

Good Shepherd Hospice of Mid-America Inc

  • Community Based Hospice Care Agency
  • Olathe, KS
National Provider Identifier
1700104718
Registry record updated Oct 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
GOOD SHEPHERD HOSPICE OF MID-AMERICA INC
Practice address
1317 S Fountain Dr
Olathe, KS 66061-7205
Phone
(913) 322-3297
Fax
(913) 948-7306
NPI assigned
May 14, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2024

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

Authorized official

Name
Mr. Jason Delester
Title
President
Phone
(405) 943-0903

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

1317 S Fountain Dr
Olathe, KS 66061-7205

Mailing address

4350 Will Rogers Pkwy
Ste 400
Oklahoma City, OK 73108-1826
Phone (405) 943-0903

Other identifiers 1

IdentifierTypeStateIssuer
10404900BMedicaidKS

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/gateway/documentsubmission/2_0/NhinService/SDRRequest_Service Other Ability Network

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100708000495 KS Part A Provider - Hospice 1850209214 Practice locations: Lawrence, KS; Olathe, KS; Garnett, KS

Hospice certification: CCN 171582

Legal name
GOOD SHEPHERD HOSPICE OF MID-AMERICA INC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Dec 28, 2011
Last certification
Jan 27, 2022
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Incorporated
Apr 24, 2001 in OK
Enrollment address
401 W Frontier LN
Ste 103
Olathe, KS 66061-7225

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Good Shepherd Hospice of Mid America IncCCN 171582
Ownership
For-Profit
Certified
Dec 28, 2011
Medicare certification status
ActiveFrom the Provider of Services file

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
17D2007902Good Shepherd Hospice of Mid-America401 W Frontier LN Suite 103, Olathe, KS 66061Certificate of waiverMay 27, 2028

National Provider Directory

National Provider Directory
Tax ID family
Ability Network2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

401 W Frontier Ln
Ste 103
Olathe, KS 66061

24 N Delaware St
Butler, MO 64730
Phone (660) 386-4101

602 Lana Dr
Ste F
Cameron, MO 64429
Phone (816) 589-2191

123 W Kansas Ave
Independence, MO 64050
Phone (816) 822-2292

25 N Lafayette Ave
Marshall, MO 65340
Phone (660) 620-7533

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Miranda Redin Individual W-2 Managing EmployeeHospice Director/Administrator Nov 28, 2015 100%
Nial K Castle Individual Contracted Managing EmployeeMD; May 5, 2009 100%
Jason Kyle Delester Individual Corporate OfficerPresident Dec 28, 2011
Shellie K Greiner Individual 5% Or Greater Direct Ownership Interest Dec 31, 2015 62.11%
Jennifer L Burrell Individual 5% Or Greater Direct Ownership Interest Dec 31, 2015 5.26%
Michael Paul Dimond Individual 5% Or Greater Direct Ownership Interest Dec 31, 2015 12.63%
Cheryl Sue Gumerson Individual 5% Or Greater Direct Ownership Interest Dec 31, 2015 5.26%
Katherine L Pierce Individual 5% Or Greater Direct Ownership Interest Dec 31, 2015 5.26%

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 8

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

NPI Registry JSON

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

{
    "created_epoch": "1273795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727827200000",
    "number": "1700104718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4350 WILL ROGERS PKWY",
            "address_2": "STE 400",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731081826",
            "telephone_number": "405-943-0903",
            "fax_number": "405-943-0950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1317 S FOUNTAIN DR",
            "city": "OLATHE",
            "state": "KS",
            "postal_code": "660617205",
            "telephone_number": "913-322-3297",
            "fax_number": "913-948-7306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SHEPHERD HOSPICE OF MID-AMERICA INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-14",
        "last_updated": "2024-10-02",
        "certification_date": "2024-10-02",
        "status": "A",
        "authorized_official_last_name": "DELESTER",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "405-943-0903",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10404900B",
            "state": "KS"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/gateway/documentsubmission/2_0/NhinService/SDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd SteB",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Olathe, KS

Sources for this page

Verify at the official NPI Registry.