NPIMap

Organization Active NPI

Ignite Medical Resort San Antonio LLC

  • Skilled Nursing Facility
  • San Antonio, TX
National Provider Identifier
1073273686
Registry record updated Dec 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
IGNITE MEDICAL RESORT SAN ANTONIO LLC
Practice address
6035 Eckhert Rd
San Antonio, TX 78240-3164
Phone
(210) 642-5300
NPI assigned
Dec 22, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2021

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

Authorized official

Name
Timothy Fields
Title
Chief Executive Officer
Phone
(630) 327-2951

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

6035 Eckhert Rd
San Antonio, TX 78240-3164

Mailing address

1550 N Northwest Hwy Ste 430
Park Ridge, IL 60068-1461

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220407000469 TX Part A Provider - Skilled Nursing Facility 5294121869 1 other NPI on this enrollment
Practice locations: San Antonio, TX

Skilled nursing facility certification: CCN 676447

Legal name
IGNITE MEDICAL RESORT SAN ANTONIO, LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF (Medicare) only
Participating since
Jun 12, 2018
Last certification
Aug 15, 2024
Beds
105
Ownership / control type
Corporation
Multi-facility organization
Ignite Medical Resort
Organization structure
LLCProprietary
Incorporated
Nov 30, 2021 in TX
Enrollment address
6035 Eckhert Rd
San Antonio, TX 78240-3164
Nursing home name
IGNITE MEDICAL RESORT SAN ANTONIO, LLC
Affiliated entity
IGNITE MEDICAL RESORTS

Care Compare: Nursing home

Medicare Care Compare
Listed as
Ignite Medical Resort San Antonio, LLCCCN 676447
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
2 of 5
Quality measures
5 of 5
Type
Medicare
Ownership
For profit - Corporation
Certified
Jun 12, 2018
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
105100.0 residents per day on average
Chain
Ignite Medical Resorts22 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2129451Ignite Medical Resort San Antonio LLC6035 Eckhert Road, San Antonio, TX 78240Certificate of waiverSep 14, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 30

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

NameRoleSinceShare
Israel Family Investment Trust Organization, Lincolnwood, IL Owned by another organization or individual Indirect Ownership Interest Apr 1, 2022 8.34%
John T McFarlane Individual Operational/Managerial Control Apr 1, 2022
Adp of the SNF Apr 1, 2022
Indirect Ownership Interest Apr 1, 2022 1.11%
Organization, Westlake Village, CA Corporation Adp of the SNF Mar 31, 2022
Jim White Individual Operational/Managerial Control Apr 1, 2022
Adp of the SNF Apr 1, 2022
Indirect Ownership Interest Apr 1, 2022 1.11%
Uzair Mushtaq Individual Operational/Managerial Control May 1, 2022
Adp of the SNF May 1, 2022
Todd a Stern Individual Managing Control - Governing BodyInvestor Apr 1, 2022
Barry Carr Individual 5% Or Greater Indirect Ownership Interest Apr 1, 2022 16%
Operational/Managerial ControlManager Apr 1, 2022 100%
Managing Control - Governing BodyManager Apr 1, 2022
Adp of the SNF Apr 1, 2022
Ignite San Antonio JV, LLC Organization, Park Ridge, IL Created for acquisition, LLC, Holding company, Owned by another organization or individual Direct Ownership Interest Apr 1, 2022 50%
Rachel Shearer Individual Operational/Managerial Control Apr 1, 2022
Adp of the SNF Apr 1, 2022
Indirect Ownership Interest Apr 1, 2022 1.11%
Jared Carr Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 1, 2025
Indirect Ownership Interest Jan 1, 2025 3.11%
Marc L Rose Individual Operational/Managerial Control Apr 1, 2022
Adp of the SNF Apr 1, 2022
Indirect Ownership Interest Apr 1, 2022 1.11%
Benjamin Israel Individual Managing Control - Governing BodyInvestor Apr 1, 2022
Gold Pearl, LLC Organization, Park Ridge, IL LLC, Holding company, Owned by another organization or individual Indirect Ownership Interest Apr 1, 2022 4%
Prestige Worldwide San Antonio, LLC Organization, Park Ridge, IL LLC, For-profit, Owned by another organization or individual Indirect Ownership Interest Apr 1, 2022 10%
Spark Therapy LLC Organization, Park Ridge, IL LLC, Medical staffing company Operational/Managerial Control Apr 1, 2022
Adp of the SNF Jun 25, 2025
Michelle Theus Individual Operational/Managerial Control Jan 1, 2023
Adp of the SNF Jan 1, 2023
Indirect Ownership Interest Jan 1, 2023 1.12%
Israel Investment TR Organization, Lincolnwood, IL Owned by another organization or individual Indirect Ownership Interest Apr 1, 2022 8.33%
Karen Gillis Individual Operational/Managerial Control Apr 1, 2022
Adp of the SNF Apr 1, 2022
Indirect Ownership Interest Apr 1, 2022 1.11%
Ryan Gobst Individual Indirect Ownership Interest Apr 1, 2022 2%
Ignite Team Partners LLC Organization, Park Ridge, IL LLC, Management services company, Consulting firm, For-profit Operational/Managerial Control Apr 1, 2022
Adp of the SNF Jun 25, 2025
Blue Pearl Financial LLC Organization, Park Ridge, IL LLC, Holding company, For-profit, Owned by another organization or individual Indirect Ownership Interest Apr 1, 2022 16%
Stern Family Investment TR Organization, Skokie, IL Owned by another organization or individual Indirect Ownership Interest Apr 1, 2022 16.66%
Organization, Johnsburg, IL LLC, Holding company, For-profit, Owned by another organization or individual Indirect Ownership Interest Apr 1, 2022 1.11%
Menachem Berger Individual Managing Control - Governing BodyInvestor Apr 1, 2022
Ignite Post Acute Solutions LLC Organization, Park Ridge, IL LLC, Holding company, For-profit, Owned by another organization or individual Indirect Ownership Interest Apr 1, 2022 20%
Ignite-Villa Holdco LLC Organization, Park Ridge, IL LLC, Holding company, For-profit, Owned by another organization or individual Direct Ownership Interest Apr 1, 2022 50%
Timothy Fields Individual 5% Or Greater Indirect Ownership Interest Apr 1, 2022 20%
Operational/Managerial ControlManager Apr 1, 2022 100%
Managing Control - Governing BodyManager Apr 1, 2022
Adp of the SNF Apr 1, 2022
Mathew Thengil Individual Operational/Managerial Control Apr 1, 2022
Adp of the SNF Apr 1, 2022
Indirect Ownership Interest Apr 1, 2022 1.11%
Berger Fam TR Ua 06252014 Organization, Chicago, IL Indirect Ownership Interest Apr 1, 2022 16.67%
Nicole Jablonski Individual Operational/Managerial Control Apr 1, 2022
Adp of the SNF Apr 1, 2022
Indirect Ownership Interest Apr 1, 2022 1.11%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 22

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

View all 22

Practitioners & affiliated clinicians

Practitioners 3

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

Affiliated clinicians 4

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": "1640131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640131200000",
    "number": "1073273686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 N NORTHWEST HWY STE 430",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6035 ECKHERT RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782403164",
            "telephone_number": "210-642-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IGNITE MEDICAL RESORT SAN ANTONIO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-22",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A",
        "authorized_official_last_name": "FIELDS",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "630-327-2951"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.