NPIMap

Organization Active NPI

La Jolla Skilled LLC

  • Skilled Nursing Facility
  • San Diego, CA
National Provider Identifier
1003198342
Registry record updated Sep 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
LA JOLLA SKILLED LLC
Practice address
3884 Nobel Drive
San Diego, CA 92122-5700
Phone
(858) 625-8700
Fax
(858) 625-8777
NPI assigned
Sep 13, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2023

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

Authorized official

Name
Ms. Soon Burnam
Title
Treasurer
Phone
(949) 540-1249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X CA Primary

Addresses

Primary practice location

3884 Nobel Drive
San Diego, CA 92122-5700

Mailing address

3884 Nobel Drive
San Diego, CA 92122-5700
Phone (858) 625-8700

Other names 1

  • The Springs at Pacific Regent La Jolla Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other eSolutions Inc.

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120315000384 CA Part A Provider - Skilled Nursing Facility 3375702012 Practice locations: San Diego, CA

Skilled nursing facility certification: CCN 555739

Legal name
LA JOLLA SKILLED LLC
Doing business as
THE SPRINGS AT PACIFIC REGENT LA JOLLA
Certification status
Active
Provider type (POS)
Nursing home – SNF (Medicare) only
Participating since
Jun 28, 1999
Last certification
Aug 25, 2023
Beds
59
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Mar 8, 2011 in NV
Enrollment address
3884 Nobel Dr
San Diego, CA 92122-5700
Nursing home name
THE SPRINGS AT PACIFIC REGENT
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
The Springs at Pacific RegentCCN 555739
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare
Ownership
For profit - Limited Liability company
Certified
Jun 28, 1999
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5956.5 residents per day on average
Chain
The Ensign Group342 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Pouya Afshar Individual Operational/Managerial Control Apr 1, 2022
Managing Control - Governing BodyMedical Director Apr 1, 2022
Adp of the SNF Apr 1, 2022
Barry Port Individual Corporate OfficerManager of Flagstone HC South LLC Oct 1, 2011
The Ensign Group Inc Organization, San Juan Capistrano, CA Corporation 5% Or Greater Indirect Ownership Interest Jan 30, 2006 100%
Adp of the SNF Oct 1, 2011
Ensign Services Inc Organization, San Juan Capistrano, CA Corporation Adp of the SNF Oct 1, 2011
Adam Willits Individual Corporate OfficerSole Manager la Jolla Skilled LLC Feb 1, 2017
Twomagnets LLC Organization, Covina, CA LLC Operational/Managerial Control Oct 1, 2011
Flagstone Healthcare South LLC Organization, San Juan Capistrano, CA LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Oct 1, 2011 100%
Nobel Health Properties LLC Organization, San Juan Capistrano, CA LLC Adp of the SNF Oct 1, 2011
Matthew Stevenson Individual Operational/Managerial ControlAdministrator Jul 15, 2016
Managing Control - Governing BodyAdministrator Jul 15, 2016
Adp of the SNF Jul 15, 2016
Chad Keetch Individual Corporate OfficerSecretary Ensign Services, Inc. Oct 1, 2011
Soon Burnam Individual Corporate OfficerSecretary of la Jolla Skilled LLC Oct 1, 2011
Managing Control - Governing BodyAuthorized Official Oct 1, 2011

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Pouya Afshar, M.D.
    • Geriatric Medicine (Internal Medicine) Physician
    • San Diego, CA
    • NPI 1184958977

    Adp of the SNF, Managing Control - Governing Body, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 60

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 60

Practitioners & affiliated clinicians

Affiliated clinicians 8

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": "1315872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694044800000",
    "number": "1003198342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3884 NOBEL DRIVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921225700",
            "telephone_number": "858-625-8700",
            "fax_number": "858-625-8777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3884 NOBEL DRIVE",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921225700",
            "telephone_number": "858-625-8700",
            "fax_number": "858-625-8777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LA JOLLA SKILLED LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-13",
        "last_updated": "2023-09-07",
        "certification_date": "2023-09-07",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "949-540-1249",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113833.3.1066.1",
            "affiliationName": "eSolutions Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "The Springs at Pacific Regent La Jolla",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Springs at Pacific Regent La Jolla",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.