NPIMap

Organization Active NPI

Good Shepherd Hospice of Springfield, LLC

  • Community Based Hospice Care Agency
  • Springfield, MO
National Provider Identifier
1720255284
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 SPRINGFIELD, LLC
Practice address
3250 S National Ave
Springfield, MO 65807-7303
Phone
(417) 881-9111
Fax
(417) 881-9115
NPI assigned
May 14, 2008
Last updated
Oct 2, 2024By the provider in NPPES
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
Manager
Phone
(405) 943-0903

Specialties & licenses 1

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

Addresses

Primary practice location

3250 S National Ave
Springfield, MO 65807-7303

Mailing address

4350 Will Rogers Pkwy
Suite 400
Oklahoma City, OK 73108-1826
Phone (800) 687-9808

Other identifiers 1

IdentifierTypeStateIssuer
1720255284MedicaidMO

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 MO

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080530000317 MO Part A Provider - Hospice 3577633783 Practice locations: Joplin, MO; Branson, MO; Springfield, MO; Lebanon, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720255284. Details of each certification follow.

Hospice certification: CCN 261638

Legal name
GOOD SHEPHERD HOSPICE OF SPRINGFIELD, LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
May 26, 2009
Last certification
Mar 12, 2020
Ownership / control type
Proprietary - Corporation
Organization structure
LLCProprietary
Enrollment address
3250 S National Ave
Springfield, MO 65807-7303

Care Compare: Hospice

Medicare Care Compare
Listed as
Good Shepherd Hospice of Springfield, LLCCCN 261638 · All quality measures
Ownership
For-Profit
Certified
May 26, 2009
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
26D1088251Good Shepherd Hospice of Springfield3250 South National, Springfield, MO 65807Certificate of waiverAug 19, 2026

National Provider Directory

National Provider Directory

Locations

670 Branson Landing Blvd
Ste 4
Branson, MO 65616
Phone (417) 544-0919

420 N Range Line Rd
Ste 11
Joplin, MO 64801
Phone (417) 768-9216

835 Howard Dr
Lebanon, MO 65536
Phone (417) 288-4113

3230 S National Ave
Springfield, MO 65807
Phone (417) 881-9111

3250 S National Ave
Springfield, MO 65807
Phone (417) 881-9111

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Jason Kyle Delester Individual Corporate OfficerBoard of Director May 14, 2008
Corporate DirectorManager May 14, 2008
W-2 Managing EmployeeManager May 14, 2008
Operational/Managerial ControlManager May 14, 2008
Captains Properties, LLC Organization, Oklahoma City, OK LLC 5% Or Greater Direct Ownership Interest Dec 31, 2015 22.22%
Kanho, Inc. Organization, Oklahoma City, OK Corporation 5% Or Greater Direct Ownership Interest Apr 21, 2015 56.67%
Shellie K Greiner Individual 5% Or Greater Indirect Ownership InterestTrustee May 14, 2008 5.55%
Jennifer L Burrell Individual 5% Or Greater Indirect Ownership Interest May 14, 2008 5.55%
Michael Paul Dimond Individual 5% Or Greater Indirect Ownership InterestTrustee May 14, 2008 18.89%
Sandra J Lowrance Individual W-2 Managing EmployeeAd; Mar 3, 2026 100%
SNJP Trust Organization, Edmond, OK 5% Or Greater Direct Ownership Interest Dec 31, 2015 18.89%
Cheryl Sue Gumerson Individual 5% Or Greater Indirect Ownership Interest May 14, 2008 5.55%
Katherine L Pierce Individual 5% Or Greater Indirect Ownership Interest May 14, 2008 5.55%
Fernando Cavero Individual Contracted Managing EmployeeMD; Jul 30, 2009 100%
Shellie K Greiner Revocable Trust Organization, Edmond, OK 5% Or Greater Indirect Ownership Interest Apr 21, 2015 62.22%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 7

Facilities that share an organizational owner with 5% or greater ownership or operational control.

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": "1210723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727827200000",
    "number": "1720255284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4350 WILL ROGERS PKWY",
            "address_2": "SUITE 400",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731081826",
            "telephone_number": "800-687-9808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3250 S NATIONAL AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658077303",
            "telephone_number": "417-881-9111",
            "fax_number": "417-881-9115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SHEPHERD HOSPICE OF SPRINGFIELD, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-14",
        "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": "MANAGER",
        "authorized_official_telephone_number": "405-943-0903",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1720255284",
            "state": "MO"
        }
    ],
    "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 Springfield, MO

Sources for this page

Verify at the official NPI Registry.