Blue Summit Hospice and Palliative Care of Roswell LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

BLUE SUMMIT HOSPICE AND PALLIATIVE CARE OF ROSWELL LLC

Practice address

1137 Alpharetta St Ste C
Roswell, GA 30075-3603

Phone

(470) 395-2510

Fax

(470) 359-5886

NPI assigned

Oct 6, 2022

Last updated

Oct 6, 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

Amanda Delpozo McKissick

Title

Manager

Phone

(678) 386-5578

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1912622549. Details of each certification follow.

• CCN 851578 Hospice · Active · Details

Hospice certification: CCN 851578

Legal name

BLUE SUMMIT HOSPICE AND PALLIATIVE CARE OF ROSWELL LLC

Doing business as

BLUE SUMMIT HOSPICE OF ROSWELL

Certification status

Active

Provider type (POS)

Hospice

Participating since

Jul 6, 2023

Last certification

Jul 6, 2023

Ownership / control type

Proprietary - Corporation

Organization structure

LLCProprietary

Incorporated

Aug 15, 2022 in GA

Enrollment address

11113 Houze Rd
Ste 100
Roswell, GA 30076-1495

Listed as

Blue Summit Hospice of RoswellCCN 851578 · All quality measures

Certified

Jul 6, 2023

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.

• Lakshman Kumar Dinavahi, MD

  • Internal Medicine Physician
  • Marietta, GA
  • NPI 1528233723

  Contracted Managing Employee

  CMS ownership

Affiliated clinicians 4

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

• Lakshman Kumar Dinavahi, MD

  • Internal Medicine Physician
  • Marietta, GA
  • NPI 1528233723

  Hospice

  Care Compare affiliation
• Amit K Dua, M.D.

  • Internal Medicine Physician
  • Cumming, GA
  • NPI 1639131691

  Hospice

  Care Compare affiliation
• Raxit Rajesh Patel, MD

  • Pulmonary Disease Physician
  • Canton, GA
  • NPI 1417118605

  Hospice

  Care Compare affiliation
• Rabia Zia

  • Family Medicine Physician
  • East Point, GA
  • NPI 1578125241

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1665014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665014400000",
    "number": "1912622549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1137 ALPHARETTA ST STE C",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300753603",
            "telephone_number": "470-395-2510",
            "fax_number": "470-359-5886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1137 ALPHARETTA ST STE C",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300753603",
            "telephone_number": "470-395-2510",
            "fax_number": "470-359-5886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE SUMMIT HOSPICE AND PALLIATIVE CARE OF ROSWELL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-06",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A",
        "authorized_official_last_name": "DELPOZO MCKISSICK",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "678-386-5578"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara R Block, CCC-SLP
• Bernice K Bloom, PT
• Ingrid Lea Bloomfield, NURSE PRACTITIONER
• Priti Shah Bloor, DDS
• Blue Line Medical Products, LLC
• Blue Summit Palliative Care LLC
• Kimberlyn Boddie, RBT
• Body G O a L S Physical Therapy & Wellness
• Jessica Ginn Boehm, M.S. CCC-SLP
• Barbara Ann Bogartz, LPC

• Community Based Hospice Care Agency in Roswell, GA
• Providers in Roswell, GA by specialty
• Community Based Hospice Care Agency in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 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.