Pediatric Services of America, LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

PEDIATRIC SERVICES OF AMERICA, LLC

Doing business as

Aveanna Healthcare

Practice address

146 New Britain Ave
Plainville, CT 06062

Phone

(860) 747-3306

Fax

(860) 747-4064

NPI assigned

Mar 2, 2007

Last updated

Jan 27, 2025By 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

Matthew Buckhalter

Title

Cfo

Phone

(470) 464-8000

Specialties & licenses 1

Addresses

Other names 1

• Aveanna Healthcare Doing business as

Medicare fee-for-service enrollment

Enrolled in PA, CT2 enrollments

Enrollment records 2

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1982733408. Details of each certification follow.

• CCN 397605 Home health agency · Active · Details
• CCN 077199 Home health agency · Active · Details

Home health agency certification: CCN 397605

Legal name

PEDIATRIC SERVICES OF AMERICA, LLC

Doing business as

AVEANNA HEALTHCARE

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Nov 2, 1994

Last certification

Apr 4, 2018

Ownership / control type

Proprietary

Organization structure

LLCProprietary

Incorporated

Dec 28, 2020 in GA

Enrollment address

2805 Old Post Rd
Ste 210
Harrisburg, PA 17110-3677

Home health agency certification: CCN 077199

Legal name

PEDIATRIC SERVICES OF AMERICA, LLC

Doing business as

AVEANNA HEALTHCARE

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Nov 18, 1993

Last certification

Jan 16, 2014

Ownership / control type

Proprietary

Organization structure

LLCProprietary

Incorporated

Dec 28, 2020 in GA

Enrollment address

1000 Bridgeport Ave
Ste 309
Shelton, CT 06484-4669

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Pediatric Services of America, LLC

  dba Aveanna Healthcare

  • Home Health Agency
  • Shelton, CT
  • NPI 1104848134

  O20070712000250

  Same enrollment
• Pediatric Services of America, LLC

  dba Aveanna Healthcare

  • Home Health Agency
  • Norwich, CT
  • NPI 1720499932

  O20070712000250

  Same enrollment
• Pediatric Services of America, LLC

  dba Aveanna Healthcare

  • Home Health Agency
  • Harrisburg, PA
  • NPI 1235168725

  O20030708000040

  Same enrollment

Listed as

Aveanna HealthcareCCN 077199 · All quality measures

Ownership

Proprietary

Certified

Nov 18, 1993

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Listed as

Aveanna HealthcareCCN 397605 · All quality measures

Ownership

Proprietary

Certified

Nov 2, 1994

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Home health aide

Locations

All disclosed owners & managing parties 20

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

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

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737936000000",
    "number": "1982733408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 INTERSTATE NORTH PKWY SE STE 1600",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303395047",
            "telephone_number": "470-464-8000",
            "fax_number": "770-248-8192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 NEW BRITAIN AVE",
            "city": "PLAINVILLE",
            "state": "CT",
            "postal_code": "06062",
            "telephone_number": "860-747-3306",
            "fax_number": "860-747-4064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC SERVICES OF AMERICA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-02",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A",
        "authorized_official_last_name": "BUCKHALTER",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "470-464-8000"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aveanna Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sara Pappaceno, MFT
• Damian Anthony Parker, MFT
• Jarred Anthony Parker, MS, PT
• Suruchi Patel
• Marisha Pearson, LCSW
• Sharon Leslie Pendleton-Ponzani, LCSW
• Jonathan Pendleton, M.D.
• Melissa Pennica
• Lisa Marie Pepe, M.A.T.
• Arlene Pereira, LCSW

• Home Health Agency in Plainville, CT
• Providers in Plainville, CT by specialty
• Home Health Agency in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; 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.