Beloved Hospice, Inc.

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

BELOVED HOSPICE, INC.

Practice address

25195 SW Parkway Ave Ste 200
Wilsonville, OR 97070-9689

Phone

(971) 236-1199

NPI assigned

Feb 27, 2023

Last updated

Mar 17, 2023By 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

Dr. Roland Jayson Pua, MD

Title

Chief Medical Officer

Phone

(702) 588-1691

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1932808078. Details of each certification follow.

• CCN 381584 Hospice · Active · Details

Hospice certification: CCN 381584

Legal name

BELOVED HOSPICE INC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Aug 9, 2023

Last certification

Aug 9, 2023

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Feb 22, 2023 in OR

Enrollment address

25195 SW Parkway Ave
Ste 200
Wilsonville, OR 97070-9689

Listed as

Beloved Hospice, IncCCN 381584 · All quality measures

Certified

Aug 9, 2023

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 5

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 2

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

• Adam Perelgut, FNP-C

  • Family Nurse Practitioner
  • Wilsonville, OR
  • NPI 1922460344

  W-2 Managing Employee

  CMS ownership
• Roland Jayson Formoso Pua, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Las Vegas, NV
  • NPI 1215009782

  5% Or Greater Direct Ownership Interest

  CMS ownership

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Beloved Hospice - Eugene LLC

  • Community Based Hospice Care Agency
  • Wilsonville, OR
  • NPI 1649075797
  NPPES parent name

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.

• Roland Jayson Formoso Pua, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Las Vegas, NV
  • NPI 1215009782
  NPD

Affiliated clinicians 1

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

• Roland Jayson Formoso Pua, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Las Vegas, NV
  • NPI 1215009782

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1677456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1679011200000",
    "number": "1932808078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29030 SW TOWN CENTER LOOP E",
            "address_2": "STE 202 PMB 462",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "97070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25195 SW PARKWAY AVE STE 200",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970709689",
            "telephone_number": "971-236-1199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELOVED HOSPICE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-27",
        "last_updated": "2023-03-17",
        "certification_date": "2023-03-17",
        "status": "A",
        "authorized_official_last_name": "PUA",
        "authorized_official_first_name": "ROLAND",
        "authorized_official_middle_name": "JAYSON",
        "authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
        "authorized_official_telephone_number": "702-588-1691",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracy M Behler, MA, CCC-SLP
• Joan Cecelia Belady, PT
• Suzanne Marie Belatti, MSPT, DPT
• Jody Bell
• Beloved Hospice - Eugene LLC
• Beloved Medical, LLC
• Beloved With You, LLC
• Sydney Nicole Belshe
• John Benassu, MA, LPC, CGAC II
• Benchmark Physical Therapy of Or, LLC

• Community Based Hospice Care Agency in Wilsonville, OR
• Providers in Wilsonville, OR by specialty
• Community Based Hospice Care Agency in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2023; 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.