Issaquah Operations, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

ISSAQUAH OPERATIONS, LLC

Doing business as

Avamere Rehabilitation of Issaquah

Practice address

805 Front St S
Issaquah, WA 98027-4205

Phone

(425) 392-1271

NPI assigned

Dec 16, 2022

Last updated

Feb 17, 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

Mary E. Kofstad

Title

Ceo

Phone

(971) 224-2033

Specialties & licenses 1

Addresses

Other names 1

• Avamere Rehabilitation of Issaquah Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053023499. Details of each certification follow.

• CCN 505004 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 505004

Legal name

ISSAQUAH OPERATIONS LLC

Doing business as

AVAMERE REHABILITATION OF ISSAQUAH

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jan 1, 1967

Last certification

Mar 27, 2025

Beds

140

Ownership / control type

Limited Liability Corporation

Multi-facility organization

Avamere

Most recent change of ownership

Mar 1, 2023

Organization structure

LLCProprietary

Enrollment address

805 Front St S
Issaquah, WA 98027-4205

Nursing home name

AVAMERE REHABILITATION OF ISSAQUAH

Affiliated entity

AVAMERE

Listed as

Avamere Rehabilitation of IssaquahCCN 505004 · All quality measures

Overall star rating

2 of 5

Health inspections

2 of 5

Staffing

2 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Jan 1, 1967

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

14093.0 residents per day on average

Chain

Avamere27 facilities in the chain

Penalties (3 years)

1Fines totaling $48,663

Processed by Care Compare on Aug 1, 2026.

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

Networks

• devoted network organization-83621310-88c0-4660-8f8d-b8ea8f4dc04e

All disclosed owners & managing parties 41

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

Owners & managing parties with NPI records 3

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

• Oksana Nesterenko, MD

  • General Practice Physician
  • Tacoma, WA
  • NPI 1871229047

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Pacific Medical Specialty Group

  • Internal Medicine Physician
  • Elma, WA
  • NPI 1548911811

  Adp of the SNF

  CMS ownership
• Misty Reid, AGACNP-BC, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Windsor, CO
  • NPI 1851992176

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

  CMS ownership

Facilities with the same owner 23

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

• Burien Operations, LLC

  dba Avamere Rehabilitation of Burien

  • Skilled Nursing Facility
  • Burien, WA
  • NPI 1912619321

  Avamere Health Services LLC, Avamere Skilled Advisors LLC, Midcap Finco LLC

  CMS ownership
• Georgian Rehab, LLC

  dba Avamere Transitional Care of Puget Sound

  • Skilled Nursing Facility
  • Tacoma, WA
  • NPI 1508904467

  Avamere Health Services LLC, Avamere Skilled Advisors LLC, Midcap Finco LLC

  CMS ownership
• Richmond Beach Rehab LLC

  • Skilled Nursing Facility
  • Shoreline, WA
  • NPI 1316932114

  Avamere Health Services LLC, Avamere Skilled Advisors LLC, Midcap Finco LLC

  CMS ownership
• Seattle Operations, LLC

  • Skilled Nursing Facility
  • Seattle, WA
  • NPI 1982948535

  Avamere Health Services LLC, Avamere Skilled Advisors LLC

  CMS ownership
• Sequim Rehabilitation LLC

  dba Avamere Olympic Rehabilitation of Sequim

  • Skilled Nursing Facility
  • Sequim, WA
  • NPI 1538146378

  Avamere Health Services LLC

  CMS ownership
• Shoreline Operations, LLC

  dba Avamere Rehabilitation of Shoreline

  • Skilled Nursing Facility
  • Shoreline, WA
  • NPI 1366154791

  Avamere Health Services LLC, Avamere Skilled Advisors LLC, Midcap Finco LLC

  CMS ownership
• SW Seattle Operations, LLC

  dba Avamere Rehabilitation of Park West

  • Skilled Nursing Facility
  • Seattle, WA
  • NPI 1336851773

  Avamere Health Services LLC, Avamere Skilled Advisors LLC, Midcap Finco LLC

  CMS ownership
• Tacoma Rehab, LLC

  dba Avamere at Pacific Ridge

  • Skilled Nursing Facility
  • Tacoma, WA
  • NPI 1053459925

  Avamere Health Services LLC, Avamere Skilled Advisors LLC, Midcap Finco LLC

  CMS ownership
• Clackamas Rehabilitation, LLC

  dba Avamere Rehabilitation of Clackamas

  • Skilled Nursing Facility
  • Gladstone, OR
  • NPI 1518001205

  Avamere Health Services LLC, Avamere Skilled Advisors LLC, Midcap Finco LLC

  CMS ownership
• Coos Bay Rehabilitation, LLC

  dba Avamere Rehabilitation of Coos Bay

  • Skilled Nursing Facility
  • Coos Bay, OR
  • NPI 1831233519

  Avamere Health Services LLC, Avamere Skilled Advisors LLC

  CMS ownership
• Crestview Operations, LLC

  dba Avamere Crestview of Portland

  • Skilled Nursing Facility
  • Portland, OR
  • NPI 1922046606

  Avamere Health Services LLC, Avamere Skilled Advisors LLC, Midcap Finco LLC

  CMS ownership
• Eugene Rehabilitation, LLC

  dba Avamere Rehabilitation of Eugene

  • Skilled Nursing Facility
  • Eugene, OR
  • NPI 1265576946

  Avamere Health Services LLC

  CMS ownership

Practitioners 3

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.

• Nishita Bhumkar, MD

  • Internal Medicine Physician
  • Bellingham, WA
  • NPI 1922268176
  NPD (past)
• Stanley Lalit Kumar Flemming, D.O.

  • Adolescent Medicine (Family Medicine) Physician
  • University Place, WA
  • NPI 1790803443
  NPD (past)
• Oksana Nesterenko, MD

  • General Practice Physician
  • Tacoma, WA
  • NPI 1871229047
  NPD (past)

Affiliated clinicians 1

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

• Oksana Nesterenko, MD

  • General Practice Physician
  • Tacoma, WA
  • NPI 1871229047

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1671148800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739750400000",
    "number": "1053023499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25115 SW PARKWAY AVE STE B",
            "city": "WILSONVILLE",
            "state": "OR",
            "postal_code": "970708891",
            "telephone_number": "503-830-8451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 FRONT ST S",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980274205",
            "telephone_number": "425-392-1271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISSAQUAH OPERATIONS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-16",
        "last_updated": "2025-02-17",
        "certification_date": "2025-02-17",
        "status": "A",
        "authorized_official_last_name": "KOFSTAD",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "971-224-2033"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinServi",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd Ste V",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Avamere Rehabilitation of Issaquah",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Avamere Rehabilitation of Issaquah",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Issaquah Medical Group
• Issaquah Medical Group
• Issaquah Medical Group PLLC
• Issaquah Natural Medicine, Inc (Issaquah Valley Natural Medicine)
• Issaquah Obstetrics and Gynecology PLLC
• Issaquah Physical Therapy, Inc
• Issaquah Plastic Surgery PLLC
• Issaquah Primary Care Associates PS
• Issaquah School District
• Issaquah Surgery Center, LLC (Issaquah Surgery Center)

• Skilled Nursing Facility in Issaquah, WA
• Providers in Issaquah, WA by specialty
• Skilled Nursing Facility in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 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.