Crater Community Hospice Inc

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

0515-15 Issued in VA

Legal business name

CRATER COMMUNITY HOSPICE INC

Practice address

3916 S Crater Rd
Petersburg, VA 23805-9202

Phone

(804) 526-4300

Fax

(804) 526-4924

NPI assigned

Jun 17, 2005

Organization subpart

No

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

Authorized official

Name

Mrs. Brenda D. Mitchell, RN, MSN, CS, CHPN

Title

Ceo

Phone

(804) 526-4300

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in VA2 enrollments

Enrollment records 2

Hospice certification: CCN 491532

Legal name

CRATER COMMUNITY HOSPICE INC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Dec 7, 1995

Last certification

Jan 24, 2020

Ownership / control type

Non-Profit - Other

Organization structure

CorporationNon-profit

Incorporated

Dec 22, 1994 in VA

Enrollment address

3916 S Crater Rd
Petersburg, VA 23805-9202

Listed as

Crater Community Hospice, IncCCN 491532

Ownership

For-Profit

Certified

Dec 7, 1995

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 14

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

Practitioners 4

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

• Heather Marie Lewis, FNP-C

  • Family Nurse Practitioner
  • North Chesterfield, VA
  • NPI 1194453902
  Medicare reassignment Care Compare group NPD
• Dorothy Anne Medina, ACNP

  • Acute Care Nurse Practitioner
  • Mechanicsville, VA
  • NPI 1710291323
  Medicare reassignment Care Compare group NPD
• Chiquita Michone Thomas-Jackson, NP

  • Adult Health Nurse Practitioner
  • Petersburg, VA
  • NPI 1184294415
  NPD
• Andrew Joseph Herman, M.D.

  • Hospitalist Physician
  • Richmond, VA
  • NPI 1366860462
  NPD (past)

Affiliated clinicians 4

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

• Erica Green Carter, M.D.

  • Family Medicine Physician
  • Farmville, VA
  • NPI 1174841894

  Hospice

  Care Compare affiliation
• Andrew Joseph Herman, M.D.

  • Hospitalist Physician
  • Richmond, VA
  • NPI 1366860462

  Hospice

  Care Compare affiliation
• David A Neff, MD

  • Family Medicine Physician
  • Hopewell, VA
  • NPI 1801874979

  Hospice

  Care Compare affiliation
• Bogdan Gabriel Paraschiv, MD

  • Internal Medicine Physician
  • Richmond, VA
  • NPI 1790080786

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1118966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1276041600000",
    "number": "1962407700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3916 S CRATER RD",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059202",
            "telephone_number": "804-526-4300",
            "fax_number": "804-526-4337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3916 S CRATER RD",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238059202",
            "telephone_number": "804-526-4300",
            "fax_number": "804-526-4924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRATER COMMUNITY HOSPICE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-17",
        "last_updated": "2010-06-09",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "804-526-4300",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN, MSN, CS, CHPN"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "VA",
            "license": "0515-15",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER ID",
            "identifier": "337221",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004910192",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deborah Goodrich Cousins, CPHT
• Susan Spencer Covington, PMHNP
• Jeri Cox
• Deborah L Craft, RN
• Crater Child Development Clinic
• Crater Vision Inc
• Creating Meaningful Solutions LLC
• Titoni Levon Crenshaw, QMHP, CSAC
• Crippled Children'S Hospital
• Jacqueline Croarkin

• Community Based Hospice Care Agency in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Community Based Hospice Care Agency in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2010; 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.