Supreme Nurses LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

SUPREME NURSES LLC

Practice address

133 Heather Rd Ste 202
Bala Cynwyd, PA 19004-3009

Phone

(585) 260-1943

NPI assigned

Feb 23, 2023

Last updated

Jun 28, 2023By 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

Bolaji Thomas

Title

President

Phone

(585) 260-1943

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1700584299. Details of each certification follow.

• CCN 398380 Home health agency · Active · Details

Home health agency certification: CCN 398380

Legal name

SUPREME NURSES LLC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Dec 12, 2024

Last certification

Dec 12, 2024

Organization structure

LLCProprietary

Incorporated

Mar 7, 2022 in PA

Enrollment address

133 Heather Rd
Ste 202
Bala Cynwyd, PA 19004-3009

Listed as

Supreme Nurses, LLCCCN 398380 · All quality measures

Ownership

-

Certified

Dec 12, 2024

Medicare certification status

ActiveFrom the Provider of Services file

Locations

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.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sharon Bolaji-Thomas

  • Family Nurse Practitioner
  • Rochester, NY
  • NPI 1194941831
  NPD (past)

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

{
    "created_epoch": "1677110400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687910400000",
    "number": "1700584299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 HEATHER RD STE 202",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190043009",
            "telephone_number": "585-260-1943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 HEATHER RD STE 202",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190043009",
            "telephone_number": "585-260-1943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPREME NURSES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-23",
        "last_updated": "2023-06-28",
        "certification_date": "2023-06-28",
        "status": "A",
        "authorized_official_last_name": "THOMAS",
        "authorized_official_first_name": "BOLAJI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "585-260-1943"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sara Marks Tabby, M.D.
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• Home Health Agency in Bala Cynwyd, PA
• Providers in Bala Cynwyd, PA by specialty
• Home Health Agency in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 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.