Blue Water Hospice, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

BLUE WATER HOSPICE, LLC

Practice address

660 S Bagdad Rd Ste 210
Leander, TX 78641-5048

Phone

(919) 667-7823

NPI assigned

May 13, 2021

Organization subpart

No

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

Authorized official

Name

Jennifer Prescott, RN

Title

Administrator

Phone

(919) 667-7823

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Hospice certification: CCN 971759

Legal name

BLUE WATER HOSPICE LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Apr 4, 2022

Last certification

Apr 4, 2022

Ownership / control type

Proprietary - Corporation

Organization structure

LLCProprietary

Incorporated

Mar 3, 2021 in TX

Enrollment address

660 S Bagdad Rd
Ste 210
Leander, TX 78641-5048

Listed as

Blue Water Hospice, LLCCCN 971759

Ownership

For-Profit

Certified

Apr 4, 2022

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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.

Affiliated clinicians 3

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

• Liam McCoy Fry, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Austin, TX
  • NPI 1952322570

  Hospice

  Care Compare affiliation
• Mauricio A Sardan, MD

  • Internal Medicine Physician
  • Austin, TX
  • NPI 1902005523

  Hospice

  Care Compare affiliation
• Khris R Ramdeen, MD

  • Internal Medicine Physician
  • Bismarck, ND
  • NPI 1861652471

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1620864000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676246400000",
    "number": "1801460076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 S BAGDAD RD STE 210",
            "city": "LEANDER",
            "state": "TX",
            "postal_code": "786415048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 S BAGDAD RD STE 210",
            "city": "LEANDER",
            "state": "TX",
            "postal_code": "786415048",
            "telephone_number": "919-667-7823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE WATER HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-05-13",
        "last_updated": "2023-02-13",
        "certification_date": "2023-02-13",
        "status": "A",
        "authorized_official_last_name": "PRESCOTT",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "919-667-7823",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Leander",
            "affiliation": "N",
            "address_1": "1407 Roaring Fork",
            "city": "Leander",
            "state": "TX",
            "country_code": "US",
            "postal_code": "78641",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Blue Water Homecare Inc.
• Bluebonnet Family Estates LLC
• Bluenile Medical Transport LLC
• Taylor Bohannan
• Henry Enrique Bolanos
• Kalen Bolton

• Community Based Hospice Care Agency in Leander, TX
• Providers in Leander, TX by specialty
• Community Based Hospice Care Agency in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 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.