Active NPI
Moments Hospice of Appleton LLC
- Community Based Hospice Care Agency
- Appleton, WI
National Provider Identifier
1982215307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- Legal business name
- MOMENTS HOSPICE OF APPLETON LLC
- Practice address
- 5517 W Waterford LN Ste C
Appleton, WI 54913-8488 - Phone
- (612) 655-5242
- NPI assigned
- Aug 10, 2020
- Last updated
- Sep 21, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Eliyahu Jaffa
- Title
- Owner
- Phone
- (715) 800-0908
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | NU | Primary |
Addresses
Primary practice location
5517 W Waterford LN Ste C
Appleton, WI 54913-8488
Mailing address
820 Lilac Dr N Ste 210
Golden Valley, MN 55422-4754
Phone (763) 205-3600
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200915002487 | WI | Part A Provider - Hospice | 0042638512 | Practice locations: Appleton, WI |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1982215307. Details of each certification follow.
Hospice certification: CCN 521606
- Legal name
- MOMENTS HOSPICE OF APPLETON LLC
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Nov 25, 2020
- Last certification
- Nov 25, 2020
- Ownership / control type
- Proprietary - Individual
- Organization structure
- LLC
- Incorporated
- Aug 5, 2020 in WI
- Enrollment address
- 5517 W Waterford LN
Ste C
Appleton, WI 54913-8488
Care Compare: Hospice
Medicare Care Compare- Listed as
- Moments Hospice of Appleton
- Ownership
- For-Profit
- Certified
- Nov 25, 2020
- Medicare certification status
- Active
National Provider Directory
National Provider DirectoryLocations
5517 W Waterford Ln
Ste C
Appleton, WI 54913
Phone (612) 655-5242
806 Valley Rd
Ste 1
Menasha, WI 54952
Ownership & related parties
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.
| Name | Role | Since | Share |
|---|---|---|---|
| Shlomo Miller | 5% Or Greater Direct Ownership Interest | Aug 5, 2020 | 50% |
| Corporate Officer | Aug 5, 2020 | 51% | |
| Eliyahu Jaffa | 5% Or Greater Direct Ownership Interest | Aug 5, 2020 | 50% |
| Operational/Managerial Control | Aug 5, 2020 | 49% | |
| Joseph Greenberg | W-2 Managing Employee | May 1, 2024 | |
| Katie Jean Wasielewski | W-2 Managing Employee | Jan 1, 2026 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- St Louis Park, MN
- NPI 1114169356
W-2 Managing Employee
Practitioners & affiliated clinicians
Affiliated clinicians 16
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": "1597017600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1695254400000",
"number": "1982215307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "820 LILAC DR N STE 210",
"city": "GOLDEN VALLEY",
"state": "MN",
"postal_code": "554224754",
"telephone_number": "763-205-3600"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5517 W WATERFORD LN STE C",
"city": "APPLETON",
"state": "WI",
"postal_code": "549138488",
"telephone_number": "612-655-5242"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MOMENTS HOSPICE OF APPLETON LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-08-10",
"last_updated": "2023-09-21",
"certification_date": "2022-07-07",
"status": "A",
"authorized_official_last_name": "JAFFA",
"authorized_official_first_name": "ELIYAHU",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "715-800-0908"
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Appleton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; 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.