Dynasty Hospice and Palliative Care Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

DYNASTY HOSPICE AND PALLIATIVE CARE INC

Practice address

6365 Van Nuys Blvd Ste 1
Van Nuys, CA 91401-2674

Phone

(818) 616-4252

NPI assigned

Aug 15, 2021

Last updated

Aug 15, 2021By 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

Tatevik Mkrtchian

Title

Ceo

Phone

(818) 616-4252

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962177535. Details of each certification follow.

• CCN B31695 Hospice · Active · Details

Hospice certification: CCN B31695

Legal name

DYNASTY HOSPICE AND PALLIATIVE CARE INC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Jan 26, 2022

Last certification

Jan 26, 2022

Ownership / control type

Proprietary - Corporation

Organization structure

CorporationProprietary

Incorporated

Nov 23, 2020 in CA

Enrollment address

6365 Van Nuys Blvd
Ste 1
Van Nuys, CA 91401-2674

Listed as

Dynasty Hospice and Palliative Care, IncCCN B31695 · All quality measures

Certified

Jan 26, 2022

Medicare certification status

ActiveFrom the Provider of Services file

Locations

All disclosed owners & managing parties 4

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.

• Rabi U. Alam, MD

  • Internal Medicine Physician
  • Van Nuys, CA
  • NPI 1821288812

  W-2 Managing Employee

  CMS ownership

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.

• Domingo Chua Barrientos, M.D.

  • Internal Medicine Physician
  • Downey, CA
  • NPI 1184685281
  NPD (past)

Affiliated clinicians 1

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

• Rabi U. Alam, MD

  • Internal Medicine Physician
  • Van Nuys, CA
  • NPI 1821288812

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1628985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628985600000",
    "number": "1962177535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6365 VAN NUYS BLVD STE 1",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914012674",
            "telephone_number": "818-616-4252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6365 VAN NUYS BLVD STE 1",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914012674",
            "telephone_number": "818-616-4252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DYNASTY HOSPICE AND PALLIATIVE CARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-15",
        "last_updated": "2021-08-15",
        "certification_date": "2021-08-15",
        "status": "A",
        "authorized_official_last_name": "MKRTCHIAN",
        "authorized_official_first_name": "TATEVIK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-616-4252"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Van Nuys, 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 Aug 15, 2021; 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.