NPIMap

Organization Active NPI

County of Putnam Office of Auditor

Doing business as Putnam County Hospice

  • Community Based Hospice Care Agency
  • Ottawa, OH
National Provider Identifier
1972509024
Registry record updated Dec 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
0109-HSP Issued in OH
Legal business name
COUNTY OF PUTNAM OFFICE OF AUDITOR
Doing business as
Putnam County Hospice
Practice address
575 O-G Road Suite 3
Ottawa, OH 45875
Phone
(419) 523-4449
Fax
(419) 523-6328
NPI assigned
Jun 23, 2005
Last updated
Dec 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2020

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

Authorized official

Name
Dr. Jacinta Eickholt, M.D.
Title
Medical Director
Phone
(419) 523-4449

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 0109-HSP OH Primary

Addresses

Primary practice location

575 O-G Road Suite 3
Ottawa, OH 45875

Mailing address

PO Box 312
Ottawa, OH 45875-0312
Phone (419) 523-4449

Other names 1

  • Putnam County Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071129000160 OH Part A Provider - Hospice 0143244566 Practice locations: Lima, OH; Ottawa, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972509024. Details of each certification follow.

Hospice certification: CCN 361594

Legal name
COUNTY OF PUTNAM OFFICE OF AUDITOR
Doing business as
PUTNAM COUNTY HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Nov 22, 1996
Last certification
Nov 13, 2009
Ownership / control type
Government - County
Organization structure
GovernmentNon-profit
Enrollment address
575 Ottawa-Glandorf Road
Suite 3
Ottawa, OH 45875-9426

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Putnam County HospiceCCN 361594 · All quality measures
Ownership
Government
Certified
Nov 22, 1996
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
County of Putnam Office of Auditor5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

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
Kimberly Rieman Individual Corporate DirectorHealth Commissioner Jul 12, 2019 100%
Operational/Managerial ControlHealth Commissioner Jul 12, 2019 100%
Christoper Trent Boop Individual Corporate DirectorDirector Sep 25, 2023 100%
W-2 Managing EmployeeAd; Sep 25, 2023 100%
Jacinta C. Eickholt Individual Corporate Director Jul 1, 2013 100%

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 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.

Affiliated clinicians 10

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": "1119484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607472000000",
    "number": "1972509024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 312",
            "city": "OTTAWA",
            "state": "OH",
            "postal_code": "458750312",
            "telephone_number": "419-523-4449",
            "fax_number": "419-523-6328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 O-G ROAD SUITE 3",
            "city": "OTTAWA",
            "state": "OH",
            "postal_code": "45875",
            "telephone_number": "419-523-4449",
            "fax_number": "419-523-6328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF PUTNAM OFFICE OF AUDITOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-23",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A",
        "authorized_official_last_name": "EICKHOLT",
        "authorized_official_first_name": "JACINTA",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "419-523-4449",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "OH",
            "license": "0109-HSP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Putnam County Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Putnam County Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ottawa, OH

Sources for this page

Verify at the official NPI Registry.