NPIMap

Organization Active NPI

Lifecare Hospice

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • Wooster, OH
National Provider Identifier
1922034701
Registry record updated Jan 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Family Medicine) PhysicianTaxonomy code 207QH0002X
License
34.003501 Issued in OH
Legal business name
LIFECARE HOSPICE
Practice address
1900 Akron Rd
Wooster, OH 44691-2518
Phone
(330) 264-4899
Fax
(330) 264-4874
NPI assigned
Jun 24, 2006
Last updated
Jan 17, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
LIFECARE HOSPICEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 17, 2020

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

Authorized official

Name
Ms. Kurt Holmes
Title
Executive Director
Phone
(330) 264-4899

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospice and Palliative Medicine (Family Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QH0002X 34.003501 OH Primary

Addresses

Primary practice location

1900 Akron Rd
Wooster, OH 44691-2518

Mailing address

1900 Akron Rd
Wooster, OH 44691-2518
Phone (330) 264-4899

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040614001154 OH Part B Supplier - Clinic/Group Practice 1052395571 Receives reassigned benefits from 10 practitioners
Practice locations: Orrville, OH; Rittman, OH; Wadsworth, OH; Walnut Creek, OH; Wooster, OH; Millersburg, OH; Loudonville, OH; Ashland, OH…

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Part of
Lifecare Hospice

Locations

1900 Akron Rd
Wooster, OH 44691
Phone (330) 264-4899

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579219200000",
    "number": "1922034701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 AKRON RD",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446912518",
            "telephone_number": "330-264-4899",
            "fax_number": "330-264-4874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 AKRON RD",
            "city": "WOOSTER",
            "state": "OH",
            "postal_code": "446912518",
            "telephone_number": "330-264-4899",
            "fax_number": "330-264-4874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFECARE HOSPICE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFECARE HOSPICE",
        "enumeration_date": "2006-06-24",
        "last_updated": "2020-01-17",
        "certification_date": "2020-01-17",
        "status": "A",
        "authorized_official_last_name": "HOLMES",
        "authorized_official_first_name": "KURT",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "330-264-4899",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207QH0002X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "OH",
            "license": "34.003501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wooster, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.