Advanced Senior Support Medical Services LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

ADVANCED SENIOR SUPPORT MEDICAL SERVICES LLC

Doing business as

Advance Senior Support Home Health
Advanced Senior Support Home Health

Practice address

855 S. Sunbury Rd Suite 206
Westerville, OH 43081

Phone

(614) 891-7480

Fax

(614) 891-7430

NPI assigned

Jun 23, 2006

Last updated

Feb 20, 2019By 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

Mr. Ronald J. Paul, RNNPI 1962555706

Title

Administrator

Phone

(614) 891-7480

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 2

• ADVANCE SENIOR SUPPORT HOME HEALTH Doing business as
• Advanced Senior Support Home Health Doing business as

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851327787. Details of each certification follow.

• CCN 368190 Home health agency · Active · Details

Home health agency certification: CCN 368190

Legal name

ADVANCED SENIOR SUPPORT MEDICAL SERVICES LLC

Doing business as

ADVANCED SENIOR SUPPORT HOME HEALTH

Certification status

Active

Provider type (POS)

Home health agency

Participating since

May 2, 2007

Last certification

Feb 22, 2018

Ownership / control type

Non-Profit

Organization structure

LLCProprietary

Incorporated

Apr 4, 2006 in OH

Enrollment address

855 S Sunbury Rd
Ste 206
Westerville, OH 43081-9553
HHA Branch

Listed as

Advanced Senior Support Home HealthCCN 368190 · All quality measures

Overall star rating

2 of 5

Ownership

Non-Profit

Certified

May 2, 2007

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Tax ID family

Advanced Senior Support Medical Services LLC2 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.

• Advanced Senior Support Medical Services LLC

  dba Advanced Senior Support Home Health

  • In Home Supportive Care Agency
  • Westerville, OH
  • NPI 1922841535
  NPD tax ID

All disclosed owners & managing parties 3

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

• Ronald Jean Paul, RN

  • Community Health Registered Nurse
  • Westerville, OH
  • NPI 1962555706
  NPD Authorized official

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1550620800000",
    "number": "1851327787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "855 S. SUNBURY RD SUITE 206",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "43081",
            "telephone_number": "614-891-7480",
            "fax_number": "614-891-7430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 S. SUNBURY RD SUITE 206",
            "city": "WESTERVILLE",
            "state": "OH",
            "postal_code": "43081",
            "telephone_number": "614-891-7480",
            "fax_number": "614-891-7430"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "855 S Sunbury Rd",
            "address_purpose": "LOCATION",
            "city": "Westerville",
            "state": "OH",
            "postal_code": "430819553",
            "country_code": "US",
            "telephone_number": "614-891-7480",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ADVANCED SENIOR SUPPORT MEDICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-23",
        "last_updated": "2019-02-20",
        "status": "A",
        "authorized_official_last_name": "PAUL",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "614-891-7480",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2742492",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ADVANCE SENIOR SUPPORT HOME HEALTH",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Advanced Senior Support Home Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Advanced Senior Support Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2019; 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.