NPIMap

Organization Active NPI

Buffalo Prairie Nursing and Rehab LLC

  • Skilled Nursing Facility
  • Buffalo, MO
National Provider Identifier
1013679596
Registry record updated Oct 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
BUFFALO PRAIRIE NURSING AND REHAB LLC
Practice address
631 W Main St
Buffalo, MO 65622-7496
Phone
(417) 345-5422
NPI assigned
Oct 12, 2021
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Bernard David Perlow
Title
Authorized Official
Phone
(443) 928-3278

Facilities with the same owner 7

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

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 1

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Buffalo Prairie Center for Rehab and HealthcareCCN 265471
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
1 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Oct 21, 1991
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6041.3 residents per day on average
Chain
Blue Sky Basin, LLC5 facilities in the chain
Special focus status
SFF Candidate
Penalties (3 years)
3Fines totaling $92,080

Processed by Care Compare on Aug 1, 2026.

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211105002028 MO Part a Provider - Skilled Nursing Facility 0244629616 Practice locations: Buffalo, MO

Skilled nursing facility certification: CCN 265471

Medicare enrollment files
Legal name
BUFFALO PRAIRIE NURSING AND REHAB LLC
Doing business as
BUFFALO PRAIRIE CENTER FOR REHAB AND HEALTHCARE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 21, 1991
Last certification
Oct 7, 2024
Beds
60
Ownership / control type
Limited Liability Corporation
Multi-facility organization
PRIME MANAGEMENT
Most recent change of ownership
Aug 31, 2021
Organization structure
LLCProprietary
Incorporated
Dec 17, 2020 in MO
Enrollment address
631 W Main St
Buffalo, MO 65622-7496
Nursing home name
BUFFALO PRAIRIE CENTER FOR REHAB AND HEALTHCARE
Affiliated entity
BLUE SKY BASIN, LLC

All disclosed owners & managing parties 9

Medicare enrollment files

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

NameRoleSinceShare
David Yitzchok Kleiner Individual 5% Or Greater Indirect Ownership Interest Aug 31, 2021 10.2%
Dkyh Missouri LLC Organization, Baltimore, MD LLC, For-profit 5% Or Greater Direct Ownership Interest Aug 31, 2021 10.2%
Samuel Stern Individual Corporate OfficerCfo Jan 1, 2023
Sloans Lake Trust Organization, Lawrence, NY LLC, For-profit 5% Or Greater Indirect Ownership Interest Aug 31, 2021 63.3%
Blue Sky Basin LLC Organization, Lawrence, NY LLC, For-profit 5% Or Greater Direct Ownership Interest Aug 31, 2021 66.66%
Bernard David Perlow Individual 5% Or Greater Indirect Ownership Interest Aug 31, 2021 23.1%
Corporate DirectorManager, Authorized Official Aug 31, 2021
Eliot Berger Individual Corporate DirectorManager, Authorized Official Aug 31, 2021
Karen S Burns Individual W-2 Managing EmployeeAdministrator Aug 31, 2021
DKDP Missouri LLC Organization, Brooklyn, NY LLC, For-profit 5% Or Greater Direct Ownership Interest Aug 31, 2021 23.1%

National Provider Directory

National Provider Directory

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

NPPES NPI Registry

Primary practice location

631 W Main St
Buffalo, MO 65622-7496

Mailing address

110 Rockaway Tpke Ste 6
Lawrence, NY 11559-1626

Other names 1

NPPES NPI Registry
  • Buffalo Prairie Center for Rehab and Healthcare Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 12, 2021.

{
    "created_epoch": "1633996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633996800000",
    "number": "1013679596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 ROCKAWAY TPKE STE 6",
            "city": "LAWRENCE",
            "state": "NY",
            "postal_code": "115591626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 W MAIN ST",
            "city": "BUFFALO",
            "state": "MO",
            "postal_code": "656227496",
            "telephone_number": "417-345-5422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUFFALO PRAIRIE NURSING AND REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-12",
        "last_updated": "2021-10-12",
        "certification_date": "2021-09-27",
        "status": "A",
        "authorized_official_last_name": "PERLOW",
        "authorized_official_first_name": "BERNARD",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "443-928-3278"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Buffalo Prairie Center for Rehab and Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Buffalo, MO

Sources for this page

Verify at the official NPI Registry.