Sudbury Pines Extended Care Facility

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

221553 Issued in MA

Legal business name

SUDBURY PINES EXTENDED CARE FACILITY

Practice address

642 Boston Post Rd
Sudbury, MA 01776-3302

Phone

(617) 512-6625

Fax

(978) 443-9510

NPI assigned

Feb 28, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Roberta C Henderson, MA

Title

Administrator

Phone

(617) 512-6625

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Sudbury Pines Hospice Doing business as

Medicare fee-for-service enrollment

Enrolled in MA

Enrollment records 1

Hospice certification: CCN 221553

Legal name

SUDBURY PINES EXTENDED CARE FACILITY

Doing business as

SUDBURY PINES HOSPICE

Certification status

Active

Provider type (POS)

Hospice

Participating since

Dec 6, 2001

Last certification

Jan 22, 2019

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Jan 25, 1971 in DE

Enrollment address

642 Boston Post Rd
Sudbury, MA 01776-3512

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Sudbury Pines Extended Care Facility

  • Skilled Nursing Facility
  • Sudbury, MA
  • NPI 1215924147

  7810912284

  Same PAC ID

Listed as

Sudbury Pines HospiceCCN 221553

Ownership

For-Profit

Certified

Dec 6, 2001

Medicare certification status

ActiveFrom the Provider of Services file

Tax ID family

Sudbury Pines Extended Care Facility2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Sudbury Pines Extended Care Facility

  • Inpatient Hospice
  • Sudbury, MA
  • NPI 1265551733
  NPD tax ID

All disclosed owners & managing parties 1

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• Sudbury Pines Extended Care Facility

  • Skilled Nursing Facility
  • Sudbury, MA
  • NPI 1215924147

  Adp of the SNF

  CMS ownership

Practitioners 1

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

• Jennifer Hardy, P.A.

  • Physician Assistant
  • Worcester, MA
  • NPI 1700846300
  NPD

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454889600000",
    "number": "1811024664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "642 BOSTON POST RD",
            "city": "SUDBURY",
            "state": "MA",
            "postal_code": "017763302",
            "telephone_number": "617-512-6625",
            "fax_number": "978-443-9510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "642 BOSTON POST RD",
            "city": "SUDBURY",
            "state": "MA",
            "postal_code": "017763302",
            "telephone_number": "617-512-6625",
            "fax_number": "978-443-9510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUDBURY PINES EXTENDED CARE FACILITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2016-02-08",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "ROBERTA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "617-512-6625",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MA",
            "license": "221553",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110024524A",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0611000",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sudbury Pines Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sudbury Neurology PLLC
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• Sudbury Pines Extended Care Facility
• Sudbury Pines Extended Care Facility
• Sudbury Senior Placement Inc
• Sudbury Speech and Language Therapy, LLC
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• Robert B Swotinsky, MD
• Sandy Tan, MSN, FNP

• Community Based Hospice Care Agency in Sudbury, MA
• Providers in Sudbury, MA by specialty
• Community Based Hospice Care Agency in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2016; 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.