NPIMap

Organization Active NPI

Preferred Hospice of Missouri Northeast LLC

Doing business as Preferred Hospice

  • Community Based Hospice Care Agency
  • Ballwin, MO
National Provider Identifier
1821025826
Registry record updated Jan 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
144-3HO Issued in MO
Legal business name
PREFERRED HOSPICE OF MISSOURI NORTHEAST LLC
Doing business as
Preferred Hospice
Practice address
301 Sovereign Court
Suite 206
Ballwin, MO 63011-4435
Phone
(636) 527-9330
Fax
(636) 527-9340
NPI assigned
Jun 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2011

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

Authorized official

Name
James C Lincoln
Title
Member
Phone
(573) 481-9625

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 146-HO MO
Community Based Hospice Care Agency 251G00000X 144-3HO MO Primary

Addresses

Primary practice location

301 Sovereign Court
Suite 206
Ballwin, MO 63011-4435

Mailing address

1220 North Main Street
Sikeston, MO 63801-4827
Phone (573) 481-9625

Other identifiers 2

IdentifierTypeStateIssuer
826224107MedicaidMO
1821025826MedicaidMO

Other names 1

  • Preferred Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050322000262 MO Part A Provider - Hospice 5698720720 Practice locations: Rolla, MO; Ballwin, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1821025826. Details of each certification follow.

Hospice certification: CCN 261610

Legal name
PREFERRED HOSPICE OF MISSOURI NORTHEAST LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Aug 24, 2005
Last certification
Mar 4, 2021
Ownership / control type
Proprietary - Individual
Organization structure
LLCProprietary
Incorporated
Oct 12, 2004 in MO
Enrollment address
301 Sovereign CT
Ste 206
Ballwin, MO 63011-4435

Care Compare: Hospice

Medicare Care Compare
Listed as
Preferred Hospice of Missouri (Northeast)CCN 261610 · All quality measures
Ownership
Other
Certified
Aug 24, 2005
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
26D1046638Preferred Hospice of Missouri301 Sovereign CT, Ste 206, Ballwin, MO 63011Certificate of waiverOct 13, 2027

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

301 Sovereign Ct
Ste 206
Ballwin, MO 63011
Phone (636) 527-9330

810 Progress Dr
Farmington, MO 63640
Phone (573) 756-9800

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Michael Spezia Individual W-2 Managing EmployeeMD; Nov 7, 2024
Elisha Nolan Individual W-2 Managing Employee Oct 24, 2023
Jeffery Hampton Individual W-2 Managing EmployeeAd; Oct 1, 2024
Lauren Lynch Individual W-2 Managing EmployeeDirector of Clinical Services Jun 6, 2024
Sean Copeland Individual W-2 Managing EmployeeDirector of Operations Jan 11, 2019
Donald R Chadwell Individual 5% Or Greater Indirect Ownership Interest Feb 1, 2008 22.5%
James C Lincoln Individual 5% Or Greater Indirect Ownership Interest Feb 1, 2008 37.5%
Corporate OfficerManaging Member of LLC Feb 1, 2008
JCJL Holdings LLC Organization, Osage Beach, MO LLC 5% Or Greater Direct Ownership Interest Feb 1, 2008 75%
Horizon Capital LLC Organization, Oklahoma City, OK LLC 5% Or Greater Direct Ownership Interest Feb 1, 2008 25%
Judy L Lincoln Individual 5% Or Greater Indirect Ownership Interest Feb 1, 2008 37.5%

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Regional HospiceSpringfield, MO, CCN 261578 Hospice 5% Or Greater Direct Ownership Interest (25%) Jul 1, 2014

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294185600000",
    "number": "1821025826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1220 NORTH MAIN STREET",
            "city": "SIKESTON",
            "state": "MO",
            "postal_code": "638014827",
            "telephone_number": "573-481-9625",
            "fax_number": "573-481-9639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 SOVEREIGN COURT",
            "address_2": "SUITE 206",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630114435",
            "telephone_number": "636-527-9330",
            "fax_number": "636-527-9340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREFERRED HOSPICE OF MISSOURI NORTHEAST LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2011-01-05",
        "status": "A",
        "authorized_official_last_name": "LINCOLN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "573-481-9625"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MO",
            "license": "146-HO",
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MO",
            "license": "144-3HO",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "826224107",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1821025826",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Preferred Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ballwin, MO

Sources for this page

Verify at the official NPI Registry.