NPIMap

Organization Active NPI

Chelsea Jewish Community, Inc.

Doing business as Chelsea Jewish Hospice and Palliative Care

  • Community Based Hospice Care Agency
  • Chelsea, MA
National Provider Identifier
1770034944
Registry record updated Jan 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
7RKJ Issued in MA
Legal business name
CHELSEA JEWISH COMMUNITY, INC.
Doing business as
Chelsea Jewish Hospice and Palliative Care
Practice address
123 Captains Row
Chelsea, MA 02150-4019
Phone
(617) 889-0811
NPI assigned
Oct 21, 2016
Last updated
Jan 9, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
CHELSEA JEWISH LIFECARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 9, 2017

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

Authorized official

Name
Adam Berman
Title
President
Phone
(978) 471-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 7RKJ MA Primary

Addresses

Primary practice location

123 Captains Row
Chelsea, MA 02150-4019

Mailing address

165 Captains Row
Chelsea, MA 02150-4019
Phone (617) 887-0001

Other identifiers 1

IdentifierTypeStateIssuer
110024502BMedicaidMA

Other names 1

  • Chelsea Jewish Hospice and Palliative Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161212001400 MA Part A Provider - Hospice 2961632708 Practice locations: Chelsea, MA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1770034944. Details of each certification follow.

Hospice certification: CCN 221584

Legal name
CHELSEA JEWISH COMMUNITY, INC.
Doing business as
LEGACY LIFECARE HOSPICE AND PALLIATIVE CARE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Aug 22, 2008
Last certification
Feb 21, 2020
Ownership / control type
Non-Profit - Other
Organization structure
CorporationNon-profit
Incorporated
Oct 24, 2007 in MA
Enrollment address
123 Captains Row
Chelsea, MA 02150-4019

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
Legacy Lifecare Hospice and Palliative CareCCN 221584 · All quality measures
Ownership
Non-Profit
Certified
Aug 22, 2008
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Chelsea Jewish Community Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

165 Captains Row
Chelsea, MA 02150
Phone (617) 887-0001

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Jeffrey Brudnick Individual Corporate Director Jan 1, 2002 9%
Sharon Forman Individual Corporate DirectorDirector Jan 1, 2017 9%
Stuart a Anfang Individual Corporate Director Oct 1, 2020 9%
Susan Goldsmith Individual Corporate Director May 1, 2013 9%
Jennifer Santerre Individual Corporate OfficerCfo Jul 1, 2022
Elizabeth Mullen Individual Corporate OfficerClerk Jan 1, 2017
Legacy Lifecare Inc Organization, Peabody, MA Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2021 100%
Karen N Madrid Individual W-2 Managing EmployeeAd; Jan 1, 2021
Operational/Managerial ControlClinical Director Jan 1, 2021
Hans P Birle Individual Corporate DirectorDirector Nov 1, 2021
Adam S Berman Individual Corporate OfficerPresident Jan 1, 2017 9%
Corporate DirectorPresident Jan 1, 2017 8%
Judy Weiss Individual Corporate Director Oct 1, 2019 9%
Douglas Fiebelkorn Individual Corporate Director Nov 1, 2022 9%
Evgenia Forman Individual Contracted Managing EmployeeMD; Mar 23, 2016
Operational/Managerial ControlMedical Director Mar 23, 2016
OtherMedical Director Jan 1, 2020
Genevieve Maclellan Individual Corporate DirectorDirector Sep 15, 2020
Gilda Richman Individual Corporate Director Jan 1, 2002 9%
Chelsea Jewish Lifecare Inc Organization, Chelsea, MA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2017 100%
Barry S Berman Individual Corporate OfficerTreasurer Jan 1, 2017
Corporate DirectorTreasurer Jan 1, 2017 9%
Howard Greenspan Individual Corporate Director Jan 1, 2018 9%
Donna Crescenzo Individual Operational/Managerial ControlController Dec 13, 2010

Owners & managing parties with NPI records 2

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

Facilities with the same owner 12

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

Change-of-ownership history 1

DateEventCounterparty
Jan 1, 2017 Change of OwnershipThis provider was the buyer Chelsea Jewish Hospice and Palliative CareCCN 221584, MA, NPI 1316133325

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Affiliated clinicians 10

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": "1477008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1483920000000",
    "number": "1770034944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 CAPTAINS ROW",
            "city": "CHELSEA",
            "state": "MA",
            "postal_code": "021504019",
            "telephone_number": "617-887-0001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 CAPTAINS ROW",
            "city": "CHELSEA",
            "state": "MA",
            "postal_code": "021504019",
            "telephone_number": "617-889-0811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHELSEA JEWISH COMMUNITY, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CHELSEA JEWISH LIFECARE, INC.",
        "enumeration_date": "2016-10-21",
        "last_updated": "2017-01-09",
        "status": "A",
        "authorized_official_last_name": "BERMAN",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "978-471-5100"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MA",
            "license": "7RKJ",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110024502B",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chelsea Jewish Hospice and Palliative Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chelsea, MA

Sources for this page

Verify at the official NPI Registry.