Blue Cross Hospice

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

BLUE CROSS HOSPICE

Practice address

4605 Lankershim Blvd Ste 305
North Hollywood, CA 91602-1875

Phone

(747) 666-1603

Fax

(747) 666-1604

NPI assigned

Nov 9, 2019

Last updated

Sep 22, 2022By 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

Gagik Vardanyan

Title

Ceo

Phone

(747) 666-1603

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902441371. Details of each certification follow.

• CCN A11587 Hospice · Active · Details

Hospice certification: CCN A11587

Legal name

BLUE CROSS HOSPICE

Certification status

Active

Provider type (POS)

Hospice

Participating since

Oct 13, 2020

Last certification

Oct 13, 2020

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Aug 1, 2019 in CA

Enrollment address

4605 Lankershim Blvd
Ste 305
North Hollywood, CA 91602-1875

Listed as

Blue Cross HospiceCCN A11587 · All quality measures

Ownership

For-Profit

Certified

Oct 13, 2020

Medicare certification status

ActiveFrom the Provider of Services file

Locations

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.

Owners & managing parties with NPI records 1

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

• Richard Keech, M.D.

  • Family Medicine Physician
  • Huntington Park, CA
  • NPI 1487748364

  W-2 Managing Employee

  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.

• Robert E Thompson

  • Pulmonary Disease Physician
  • Northridge, CA
  • NPI 1982675666
  NPD (past)

Affiliated clinicians 1

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

• Robert E Thompson

  • Pulmonary Disease Physician
  • Northridge, CA
  • NPI 1982675666

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1573257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663804800000",
    "number": "1902441371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4605 LANKERSHIM BLVD STE 305",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916021875",
            "telephone_number": "747-666-1603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4605 LANKERSHIM BLVD STE 305",
            "city": "NORTH HOLLYWOOD",
            "state": "CA",
            "postal_code": "916021875",
            "telephone_number": "747-666-1603",
            "fax_number": "747-666-1604"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE CROSS HOSPICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-09",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A",
        "authorized_official_last_name": "VARDANYAN",
        "authorized_official_first_name": "GAGIK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "747-666-1603"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marie Kathleen Block, M.A.
• Edward Harrison Bloom
• Blooming Home Health Care, Inc
• Blue Cross Elderly Care
• Blue Horizon Eldercare LLC
• Blue Horizon Eldercare LLC
• Bluelighthomecare LLC
• Michael Bradley Blum, DC
• Geo Blunden

• Community Based Hospice Care Agency in North Hollywood, CA
• Providers in North Hollywood, CA by specialty
• Community Based Hospice Care Agency in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2022; 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.