NPIMap

Organization Active NPI

PNW Hospice, LLC

  • Community Based Hospice Care Agency
  • Tacoma, WA
National Provider Identifier
1962197822
Registry record updated Apr 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
PNW HOSPICE, LLC
Practice address
1313 Broadway Ste 500
Tacoma, WA 98402-3499
Phone
(253) 301-6400
Fax
(253) 301-6490
NPI assigned
Apr 6, 2023
Last updated
Apr 6, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2023

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

Authorized official

Name
William Glenn Robertson
Title
Ceo
Phone
(253) 403-1272

Specialties & licenses 1

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

Addresses

Primary practice location

1313 Broadway Ste 500
Tacoma, WA 98402-3499

Mailing address

P.O. Box 5299
Ms: 1313-5-Pco
Tacoma, WA 98415

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240118002727 WA Part A Provider - Hospice 7315399052 Practice locations: Tacoma, WA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962197822. Details of each certification follow.

Hospice certification: CCN 501555

Legal name
PNW HOSPICE LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Apr 10, 2024
Last certification
Apr 4, 2024
Organization structure
LLCProprietary
Incorporated
Nov 30, 2020 in WA
Enrollment address
1313 Broadway
Ste 500
Tacoma, WA 98402-3499

Care Compare: Hospice

Medicare Care Compare
Listed as
PNW Hospice LLCCCN 501555 · All quality measures
Certified
Apr 10, 2024
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
50D2288406PNW Hospice1313 Broadway Ste 500, Tacoma, WA 98402Certificate of waiverApr 4, 2028

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1313 Broadway
Ste 500
Tacoma, WA 98402
Phone (253) 301-6400

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Donald Thompson Individual W-2 Managing EmployeeAdministrator May 3, 2023
William G Robertson Individual Corporate OfficerCeo May 1, 2014
W-2 Managing EmployeeCeo Apr 1, 2014
Melissa Chubbuck Individual W-2 Managing EmployeeMedical Director May 3, 2023
Leslie Dale Sowell Individual Corporate Director Jan 1, 2001
Robert Yost Individual Corporate Director Jan 1, 2006
John Wiborg Individual Corporate Director Jan 1, 2002
Tariq Salam Individual Corporate Director Nov 1, 2020
W-2 Managing Employee Nov 1, 2020
James Gyeong-Jin Lee Individual Corporate OfficerExec VP & Cfo Jun 1, 2022
W-2 Managing EmployeeExec VP & Cfo Jun 1, 2022
Tara Perry Individual Corporate Director Aug 25, 2021
Florence Chang Individual Corporate OfficerPresident Apr 1, 2015
W-2 Managing EmployeePresident Jan 1, 2015
Robin J Thomashauer Individual Corporate Director Nov 1, 2020
Janine Terrano Individual Corporate Director Jan 1, 2013
Frank Tombari Individual Corporate Director Jan 28, 2022
Deedee Walkey Individual Corporate Director Jan 1, 2010
Sally Leighton Individual Corporate Director Jan 1, 2001
Multicare Health System Organization, Tacoma, WA 5% Or Greater Direct Ownership Interest May 3, 2023 100%

Owners & managing parties with NPI records 2

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

  • Tariq Salam, MD
    • Clinical Cardiac Electrophysiology Physician
    • Tacoma, WA
    • NPI 1043294291

    Corporate Director, W-2 Managing Employee

    CMS ownership
  • Melissa Chubbuck
    • Hospice and Palliative Medicine (Internal Medicine) Physician
    • Denver, CO
    • NPI 1477907384

    W-2 Managing Employee

    CMS ownership

Facilities with the same owner 20

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 20

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1680739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680739200000",
    "number": "1962197822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 5299",
            "address_2": "MS: 1313-5-PCO",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "98415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1313 BROADWAY STE 500",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984023499",
            "telephone_number": "253-301-6400",
            "fax_number": "253-301-6490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PNW HOSPICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-06",
        "last_updated": "2023-04-06",
        "certification_date": "2023-03-07",
        "status": "A",
        "authorized_official_last_name": "ROBERTSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "GLENN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "253-403-1272"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tacoma, WA

Sources for this page

Verify at the official NPI Registry.