Hospice of Montezuma, Inc.

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

License

2003-HOSPCIE-940 Issued in CO

Legal business name

HOSPICE OF MONTEZUMA, INC.

Practice address

512 N Broadway
Cortez, CO 81321-2002

Phone

(970) 565-4400

Fax

(970) 565-9543

NPI assigned

May 5, 2006

Last updated

Jul 20, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Carol A Baumgartner

Title

Executive Director

Phone

(970) 565-4400

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1982652350. Details of each certification follow.

• CCN 061522 Hospice · Active · Details

Hospice certification: CCN 061522

Legal name

HOSPICE OF MONTEZUMA, INC.

Certification status

Active

Provider type (POS)

Hospice

Participating since

Aug 10, 1989

Last certification

Jul 13, 2022

Ownership / control type

Non-Profit - Private

Organization structure

CorporationNon-profit

Incorporated

May 24, 1989 in CO

Enrollment address

512 N Broadway
Cortez, CO 81321-2002

Listed as

Hospice of Montezuma IncCCN 061522 · All quality measures

Ownership

Non-Profit

Certified

Aug 10, 1989

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 8

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

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.

• Courtney Michelle Jones, M.D.

  • Family Medicine Physician
  • Cortez, CO
  • NPI 1316234172
  NPD (past)
• Mary K Rousset, NP

  • Women's Health Nurse Practitioner
  • Cortez, CO
  • NPI 1063716215
  NPD (past)

Affiliated clinicians 4

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

• Jason Mack Eversole, D.O.

  • Family Medicine Physician
  • Mancos, CO
  • NPI 1699159178

  Hospice

  Care Compare affiliation
• Jocelyn Hirschman, MD

  • Family Medicine Physician
  • Cortez, CO
  • NPI 1083926091

  Hospice

  Care Compare affiliation
• Jameson Laub, DO

  • Family Medicine Physician
  • Cortez, CO
  • NPI 1851956387

  Hospice

  Care Compare affiliation
• David D Wensel, DO

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • Topeka, KS
  • NPI 1699789982
  Care Compare affiliation

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626739200000",
    "number": "1982652350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 740",
            "city": "CORTEZ",
            "state": "CO",
            "postal_code": "813210740",
            "telephone_number": "970-565-4400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 N BROADWAY",
            "city": "CORTEZ",
            "state": "CO",
            "postal_code": "813212002",
            "telephone_number": "970-565-4400",
            "fax_number": "970-565-9543"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOSPICE OF MONTEZUMA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-05",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-20",
        "status": "A",
        "authorized_official_last_name": "BAUMGARTNER",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "970-565-4400"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "CO",
            "license": "2003-HOSPCIE-940",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126214",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "022064",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jocelyn Hirschman, MD
• Julie Kay Hite, RN
• Leroy Kenneth Holley, LPN
• Mark Holton, BCBA, LPC
• Hope K. Barkhurst, M.D., P.C.
• Tami Jean Houser, MED-CCC-SLP
• Kirstin Thoreen Howell, APN-NP
• Korby Jon Howell, PA-C
• Neal C Hurst, PHARMD
• Joni Marie Indiek

• Community Based Hospice Care Agency in Cortez, CO
• Providers in Cortez, CO by specialty
• Community Based Hospice Care Agency in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2021; 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.