NPIMap

Organization Active NPI

Hospice of Montana II LLC

  • Community Based Hospice Care Agency
  • Bozeman, MT
National Provider Identifier
1720601115
Registry record updated May 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
HOSPICE OF MONTANA II LLC
Practice address
5 W Mendenhall St Ste 202
Bozeman, MT 59715-3566
Phone
(406) 404-2266
Fax
(406) 404-2227
NPI assigned
May 20, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2020

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

Authorized official

Name
Trace Bedwell
Title
Executive Director
Phone
(406) 404-2266

Specialties & licenses 1

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

Addresses

Primary practice location

5 W Mendenhall St Ste 202
Bozeman, MT 59715-3566

Mailing address

5 W Mendenhall St Ste 202
Bozeman, MT 59715-3566
Phone (406) 404-2266

Other names 1

  • Stillwater Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200515001142 MT Part A Provider - Hospice 3375974991 Practice locations: Bozeman, MT

Hospice certification: CCN 271539

Legal name
HOSPICE OF MONTANA II LLC
Doing business as
STILLWATER HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Dec 12, 2020
Last certification
Dec 12, 2020
Ownership / control type
Proprietary - Partnership
Organization structure
LLCProprietary
Incorporated
Jul 11, 2018 in MT
Enrollment address
233 Edelweiss Dr
Ste 11
Bozeman, MT 59718-3935

Care Compare: Hospice

Medicare Care Compare
Listed as
Stillwater of HospiceCCN 271539
Ownership
For-Profit
Certified
Dec 12, 2020
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
27D2194864Hospice of Montana II LLC233 Edelweiss Unit 11, Bozeman, MT 59718Certificate of waiverOct 4, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Christopher a Graham Individual 5% Or Greater Direct Ownership Interest May 28, 2021 33.3%
Corporate OfficerManaging Member Apr 20, 2020
W-2 Managing EmployeeCfo Apr 20, 2020
Randall Swenson Individual 5% Or Greater Direct Ownership Interest May 28, 2021 33.3%
Matthew R Warnick Individual 5% Or Greater Direct Ownership Interest May 28, 2021 33.3%
Trace L Bedwell Individual Contracted Managing EmployeeExecutive Director Apr 20, 2020

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 9

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": "1589932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589932800000",
    "number": "1720601115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5 W MENDENHALL ST STE 202",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597153566",
            "telephone_number": "406-404-2266",
            "fax_number": "406-404-2227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 W MENDENHALL ST STE 202",
            "city": "BOZEMAN",
            "state": "MT",
            "postal_code": "597153566",
            "telephone_number": "406-404-2266",
            "fax_number": "406-404-2227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPICE OF MONTANA II LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-20",
        "last_updated": "2020-05-20",
        "certification_date": "2020-05-20",
        "status": "A",
        "authorized_official_last_name": "BEDWELL",
        "authorized_official_first_name": "TRACE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "406-404-2266"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stillwater Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bozeman, MT

Sources for this page

Verify at the official NPI Registry.