With Grace Ministries Inc.

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

WITH GRACE MINISTRIES INC.

Doing business as

With Grace Hospice and Palliative Care

Practice address

1879 Lundy Ave
Suite 233
San Jose, CA 95131-1856

Phone

(408) 649-6712

NPI assigned

Oct 8, 2014

Last updated

Oct 8, 2014By 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

Mrs. Linh N Le, R.N.

Title

Corporate Secretary

Phone

(408) 600-4833

Specialties & licenses 1

Addresses

Other names 1

• With Grace Hospice and Palliative Care Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952704645. Details of each certification follow.

• CCN 751644 Hospice · Active · Details

Hospice certification: CCN 751644

Legal name

WITH GRACE MINISTRIES INC.

Doing business as

WITH GRACE HOSPICE AND PALLIATIVE CARE

Certification status

Active

Provider type (POS)

Hospice

Participating since

Jun 15, 2015

Last certification

Apr 27, 2018

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Aug 18, 2014 in CA

Enrollment address

4075 Evergreen Village SQ
Ste 210
San Jose, CA 95135-1766

Listed as

With Grace Hospice and Palliative CareCCN 751644 · All quality measures

Ownership

For-Profit

Certified

Jun 15, 2015

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 2

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.

• Marvin Phillip Masada, MD.

  • Family Medicine Physician
  • San Jose, CA
  • NPI 1891851929

  5% Or Greater Direct Ownership Interest, W-2 Managing Employee

  CMS ownership

Practitioners 2

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.

• Marvin Phillip Masada, MD.

  • Family Medicine Physician
  • San Jose, CA
  • NPI 1891851929
  NPD
• Sabine Dorothea Haas, FNP-BC

  • Family Nurse Practitioner
  • Oakland, CA
  • NPI 1114567500
  NPD (past)

Affiliated clinicians 1

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

• Marvin Phillip Masada, MD.

  • Family Medicine Physician
  • San Jose, CA
  • NPI 1891851929

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1412726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412726400000",
    "number": "1952704645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1879 LUNDY AVE",
            "address_2": "SUITE 233",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951311856",
            "telephone_number": "408-649-6712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1879 LUNDY AVE",
            "address_2": "SUITE 233",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951311856",
            "telephone_number": "408-649-6712"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WITH GRACE MINISTRIES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-08",
        "last_updated": "2014-10-08",
        "status": "A",
        "authorized_official_last_name": "LE",
        "authorized_official_first_name": "LINH",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CORPORATE SECRETARY",
        "authorized_official_telephone_number": "408-600-4833",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "With Grace Hospice and Palliative Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jerald E. Wisdom, MD
• Chelsea Kathryn Wise-Diangson, LMFT
• Dominique Wise
• Kathryn Wise, OTD
• Rachael Morgan Wise, PA-C
• Lynn Withers
• Withyou Care LLC
• David R. Witt, MD
• Gerald George Witters, CADC1
• Deborah Anne Wittwer Kopp, PHD

• Community Based Hospice Care Agency in San Jose, CA
• Providers in San Jose, 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 Oct 8, 2014; 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.