Graciouscare Hospice, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

GRACIOUSCARE HOSPICE, LLC

Doing business as

Gracious Care Hospice, LLC

Practice address

8196 SW Hall Blvd Ste 101
Beaverton, OR 97008-4676

Phone

(503) 989-1588

NPI assigned

Aug 7, 2020

Last updated

Jun 21, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Andreea Benea

Title

Representative

Phone

(503) 893-9866

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Gracious Care Hospice, LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in OR2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831709567. Details of each certification follow.

• CCN 381575 Hospice · Active · Details

Hospice certification: CCN 381575

Legal name

GRACIOUSCARE HOSPICE, LLC

Doing business as

GRACIOUS CARE HOSPICE

Certification status

Active

Provider type (POS)

Hospice

Participating since

Sep 20, 2021

Last certification

Sep 20, 2021

Ownership / control type

Proprietary - Corporation

Organization structure

LLCProprietary

Enrollment address

8196 SW Hall Blvd
Ste 101, 3Rd Floor
Beaverton, OR 97008-4676

Listed as

Gracious Care HospiceCCN 381575 · All quality measures

Ownership

For-Profit

Certified

Sep 20, 2021

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

Locations

All disclosed owners & managing parties 7

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

Owners & managing parties with NPI records 1

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

• Mohamed Refaat, MD

  • Hospitalist Physician
  • Bend, OR
  • NPI 1053607457

  Corporate Director

  CMS ownership

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mohamed Refaat, MD

  • Hospitalist Physician
  • Bend, OR
  • NPI 1053607457

  Family Medicine

  Medicare reassignment NPD

Affiliated clinicians 4

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

• Nicholas Barber, MD

  • Hematology & Oncology Physician
  • Salem, OR
  • NPI 1508033465

  Hospice

  Care Compare affiliation
• Jose S De la Cruz, MD

  • Family Medicine Physician
  • Tigard, OR
  • NPI 1003174285

  Hospice

  Care Compare affiliation
• Chang Min Lee, MD

  • Internal Medicine Physician
  • Portland, OR
  • NPI 1962066100

  Hospice

  Care Compare affiliation
• Mohamed Refaat, MD

  • Hospitalist Physician
  • Bend, OR
  • NPI 1053607457

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1596758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1624233600000",
    "number": "1831709567",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8196 SW HALL BLVD STE 101",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970084676",
            "telephone_number": "503-893-9866",
            "fax_number": "866-844-0277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8196 SW HALL BLVD STE 101",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970084676",
            "telephone_number": "503-989-1588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRACIOUSCARE HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-07",
        "last_updated": "2021-06-21",
        "certification_date": "2021-06-21",
        "status": "A",
        "authorized_official_last_name": "BENEA",
        "authorized_official_first_name": "ANDREEA",
        "authorized_official_title_or_position": "REPRESENTATIVE",
        "authorized_official_telephone_number": "503-893-9866"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "16-1083",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gracious Care Hospice, LLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gracious Care Hospice, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Miles Joseph Goritski
• Marcel Gose, OTR/L
• Marcelle Gotting, LMT
• Samuel Gottlieb, D.D.S.
• Robert Peter Goyette
• David Graf, RPH
• Roseana Virginia Granado
• Erin Elizabeth Grant
• Leah Grant
• Nancy Graser

• Community Based Hospice Care Agency in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Community Based Hospice Care Agency in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2021; 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.