1818 Como Park Boulevard Operating Company LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

1818 COMO PARK BOULEVARD OPERATING COMPANY LLC

Doing business as

Elderwood at Lancaster

Practice address

1818 Como Park Blvd
Lancaster, NY 14086-2824

Phone

(716) 683-6165

NPI assigned

Feb 10, 2012

Last updated

Jan 19, 2023By 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

Dr. Jeffrey Rubin

Title

Co-Chief Executive Officer

Phone

(716) 817-5075

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Elderwood at Lancaster Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053684720. Details of each certification follow.

• CCN 335577001 Skilled nursing facility · Details

Skilled nursing facility certification: CCN 335577001

Legal name

1818 COMO PARK BOULEVARD OPERATING COMPANY, LLC

Doing business as

ELDERWOOD AT LANCASTER

Organization structure

LLCProprietary

Incorporated

Oct 12, 2011 in NY

Enrollment address

1818 Como Park Blvd
Lancaster, NY 14086-2824

Nursing home name

ELDERWOOD AT LANCASTER

Affiliated entity

ELDERWOOD

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 3

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

Practitioners 4

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.

• Margaret M Eberl, MD MPH

  • Family Medicine Physician
  • Buffalo, NY
  • NPI 1669466843
  NPD (past)
• Michael Henry Kueker, MD

  • Family Medicine Physician
  • Buffalo, NY
  • NPI 1013414986
  NPD (past)
• Ryan James Mikac, D.O.

  • Family Medicine Physician
  • Amherst, NY
  • NPI 1346502689
  NPD (past)
• Paul Eugene Shields, DO

  • Family Medicine Physician
  • Erie, PA
  • NPI 1508861949
  NPD (past)

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

{
    "created_epoch": "1328832000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674086400000",
    "number": "1053684720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 SENECA ST STE 100",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142041963",
            "telephone_number": "716-633-3900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 COMO PARK BLVD",
            "city": "LANCASTER",
            "state": "NY",
            "postal_code": "140862824",
            "telephone_number": "716-683-6165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1818 COMO PARK BOULEVARD OPERATING COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-10",
        "last_updated": "2023-01-19",
        "certification_date": "2023-01-19",
        "status": "A",
        "authorized_official_last_name": "RUBIN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "CO-CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "716-817-5075",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01542621",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elderwood at Lancaster",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Elderwood at Lancaster",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hope Ackerly
• Albert J Addesa Jr., MD
• Jessica H Allen, LCSW
• Krista Marie Anastasi
• Monie Applegate, DDS

• Skilled Nursing Facility in Lancaster, NY
• Providers in Lancaster, NY by specialty
• Skilled Nursing Facility in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; 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.