NPIMap

Organization Active NPI

Optum Palliative and Hospice Care, Inc.

Doing business as Evercare Hospice, Inc.

  • Community Based Hospice Care Agency
  • Dayton, OH
National Provider Identifier
1922274844
Registry record updated Nov 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
0158HSP Issued in OH
Legal business name
OPTUM PALLIATIVE AND HOSPICE CARE, INC.
Doing business as
Evercare Hospice, Inc.
Practice address
7755 Paragon Road
Suite 106
Dayton, OH 45459-4052
Phone
(937) 226-8611
Fax
(888) 810-8182
NPI assigned
Apr 30, 2008
Last updated
Nov 4, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
COLLABORATIVE CARE HOLDINGS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 4, 2015

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

Authorized official

Name
John O. Enderle
Title
President/Ceo
Phone
(860) 221-0793

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X NU
Community Based Hospice Care Agency 251G00000X 0158HSP OH Primary

Addresses

Primary practice location

7755 Paragon Road
Suite 106
Dayton, OH 45459-4052

Mailing address

PO Box 15645
Las Vegas, NV 89114-5645
Phone (215) 902-8241

Other names 1

  • Evercare Hospice, Inc. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Partners Group Direct Equity 2019 (Usd) Rebalancing Access L.P Organization, Minnetonka, MN LLC 5% Or Greater Indirect Ownership Interest Dec 2, 2011
Unitedhealth Group Incorporated Organization, Minnetonka, MN Corporation 5% Or Greater Indirect Ownership Interest Dec 1, 2011
Jennie Roberts Individual Corporate Director Apr 30, 2003
W-2 Managing Employee Apr 30, 2003
John O Enderle Individual Corporate Director Nov 11, 2013
Collaborative Care Holdings LLC Organization, Minnetonka, MN LLC 5% Or Greater Direct Ownership Interest Dec 1, 2011 100%
Robert W Oberrender Individual Corporate Officer Jun 7, 2013
United Healthcare Services Inc Organization, Minnetonka, MN For-profit 5% Or Greater Indirect Ownership Interest Oct 1, 2012 100%
James a Mittelberger Individual Corporate Director May 13, 2013
Cynthia Seiwert Individual Corporate Officer Jun 25, 2013
Corporate Director Jun 25, 2013
W-2 Managing Employee Jun 25, 2013
Optum Inc Organization, Minnetonka, MN Corporation 5% Or Greater Indirect Ownership Interest Dec 2, 2011
John G Liethen Individual Corporate OfficerSecretary Jun 7, 2013

NPI Registry JSON

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

{
    "created_epoch": "1209513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446595200000",
    "number": "1922274844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 15645",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891145645",
            "telephone_number": "215-902-8241",
            "fax_number": "215-902-8809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7755 PARAGON ROAD",
            "address_2": "SUITE 106",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454594052",
            "telephone_number": "937-226-8611",
            "fax_number": "888-810-8182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUM PALLIATIVE AND HOSPICE CARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLLABORATIVE CARE HOLDINGS, LLC",
        "enumeration_date": "2008-04-30",
        "last_updated": "2015-11-04",
        "status": "A",
        "authorized_official_last_name": "ENDERLE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "860-221-0793"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "OH",
            "license": "0158HSP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evercare Hospice, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dayton, OH

Sources for this page

Verify at the official NPI Registry.