NPIMap

Organization Active NPI

Symponia Hospice

  • Community Based Hospice Care Agency
  • Decatur, GA
National Provider Identifier
1952848384
Registry record updated Jul 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
SYMPONIA HOSPICE
Practice address
4288 Memorial Dr Ste B
Decatur, GA 30032-1229
Phone
(770) 456-5701
Fax
(404) 382-8643
NPI assigned
Jan 24, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2024

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

Authorized official

Name
Pamela Houser
Title
Ceo
Phone
(770) 456-5701

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

4288 Memorial Dr Ste B
Decatur, GA 30032-1229

Mailing address

4288 Memorial Dr Ste B
Decatur, GA 30032-1229
Phone (770) 456-5701

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171026003264 GA Part A Provider - Hospice 3779859293 Practice locations: Decatur, GA

Hospice certification: CCN 111796

Legal name
SYMPONIA HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Apr 16, 2018
Last certification
Jun 3, 2021
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Enrollment address
4288 Memorial Dr
Ste B
Decatur, GA 30032-1229

Care Compare: Hospice

Medicare Care Compare
Listed as
Symponia HospiceCCN 111796
Ownership
For-Profit
Certified
Apr 16, 2018
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

699 Piedmont Ave NE
Atlanta, GA 30308
Phone (404) 872-8837

Ownership & related parties

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.

NameRoleSinceShare
Angel Brown Boulware Individual 5% Or Greater Direct Ownership InterestSecretary Jan 26, 2017 33.33%
W-2 Managing EmployeeMD; Jan 17, 2017
Alan Jay Novoselsky Individual 5% Or Greater Direct Ownership InterestCfo Jan 26, 2017 33.33%
Pamela Houser Individual 5% Or Greater Direct Ownership InterestCeo Jan 26, 2017 33.33%
W-2 Managing EmployeeAd; Jan 26, 2017

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 3

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

NPI Registry JSON

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

{
    "created_epoch": "1485216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1720569600000",
    "number": "1952848384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4288 MEMORIAL DR STE B",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300321229",
            "telephone_number": "770-456-5701",
            "fax_number": "404-382-8643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4288 MEMORIAL DR STE B",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300321229",
            "telephone_number": "770-456-5701",
            "fax_number": "404-382-8643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SYMPONIA HOSPICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-24",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A",
        "authorized_official_last_name": "HOUSER",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "770-456-5701"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

Verify at the official NPI Registry.