County of Putnam Office of Auditor
Organization Active NPI Community Based Hospice Care Agency · Ottawa, OH
NPI 1972509024 · NPPES record last updated Dec 9, 2020
Key facts
- NPI
- 1972509024
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- License
- 0109-HSP (OH)
- Legal business name
- COUNTY OF PUTNAM OFFICE OF AUDITOR
- Practice address
- 575 O-G Road Suite 3
Ottawa, OH 45875 - Phone
- (419) 523-4449
- Fax
- (419) 523-6328
- NPI assigned
- Jun 23, 2005
- Organization subpart
- No
Authorized official
- Name
- Dr. Jacinta Eickholt, M.D.
- Title
- Medical Director
- Phone
- (419) 523-4449
Owners & managing parties with NPI records 1
Other NPIs with the same Medicare PAC ID 4
Corporate family (same tax ID) 4
Practitioners 3
-
Brooke M Cassidy, CNP
-
Stacy Jo Klass, CNP
Affiliated clinicians 10
-
James O Doone, MD
-
Melinda S Fritz, MD
-
Salim W Hanna, M.D.
-
Darrel Hotmire, DO
-
Mandy A Klass, M.D.
-
Wesley A Klir, MD
-
Gary E Okuley, M.D.
Medicare Care Compare: Hospice
- Listed as
- Putnam County Hospice
- Ownership
- Government
- Certified
- Nov 22, 1996
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
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
- Government · Non-profit
- Enrollment address
- 575 Ottawa-Glandorf Road
Suite 3
Ottawa, OH 45875-9426
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Kimberly Rieman |
Corporate Director |
Jul 12, 2019 | 100% |
| Operational/Managerial Control |
Jul 12, 2019 | 100% | |
| Christoper Trent Boop |
Corporate Director |
Sep 25, 2023 | 100% |
| W-2 Managing Employee |
Sep 25, 2023 | 100% | |
| Jacinta C. Eickholt |
Corporate Director | Jul 1, 2013 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071129000160 | OH | Part a Provider - Hospice | 0143244566 | Practice locations: Lima, OH; Ottawa, OH |
National Provider Directory
- Tax ID family
- County of Putnam
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 0109-HSP | OH | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0389511 | Medicaid | OH | |
| 000000233040 | Other | OH | ANTHEM BCBS |
Other names
- Putnam County Hospice
Other providers in Ottawa, OH
- Coja Enterprises, LLC
- County of Putnam
- County of Putnam Office of Auditor
- County of Putnam Office of Auditor
- County of Putnam Office of Auditor
- Jessica C. Cox
- Amber R Cross
- Kayla Croy
- Brian Dean
- Wanda Jo Dean
All providers in Ottawa, OH · Community Based Hospice Care Agency in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 9, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.