Summerhill, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1-076-1106 Issued in GA

Legal business name

SUMMERHILL, LLC

Practice address

500 Stanley St
Perry, GA 31069-3145

Phone

(478) 987-3100

Fax

(478) 987-0664

NPI assigned

Oct 17, 2005

Last updated

Apr 13, 2012By 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

Mr. William C. Davis Jr.

Title

President

Phone

(478) 988-1294

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA2 enrollments

Enrollment records 2

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083603609. Details of each certification follow.

• CCN 115430 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 115430

Legal name

SUMMERHILL, LLC

Doing business as

SUMMERHILL

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Sep 1, 1989

Last certification

Sep 5, 2024

Beds

160

Ownership / control type

Limited Liability Corporation

Organization structure

LLCProprietary

Enrollment address

500 Stanley St
Perry, GA 31069-3145

Nursing home name

SUMMERHILL ELDERLIVING HOME & CARE

Affiliated entity

CROSSROADS MEDICAL MANAGEMENT

Listed as

Summerhill Elderliving Home & CareCCN 115430 · All quality measures

Overall star rating

1 of 5

Health inspections

2 of 5

Staffing

4 of 5

Quality measures

1 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Sep 1, 1989

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

160137.4 residents per day on average

Chain

Crossroads Medical Management6 facilities in the chain

Penalties (3 years)

3Fines totaling $86,129

Processed by Care Compare on Aug 1, 2026.

Locations

All disclosed owners & managing parties 12

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 1

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

• Appavuchetty Soundappan, MD

  • Internal Medicine Physician
  • Perry, GA
  • NPI 1912951500

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Facilities with the same owner 3

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

• Bayview Nursing Home, LLC

  • Skilled Nursing Facility
  • Nahunta, GA
  • NPI 1053300566

  Crossroads Medical Management, Inc.

  CMS ownership
• Rockmart Health, LLC

  • Skilled Nursing Facility
  • Rockmart, GA
  • NPI 1538512256

  Crossroads Medical Management, Inc.

  CMS ownership
• Sears Nursing Home, LLC

  • Skilled Nursing Facility
  • Brunswick, GA
  • NPI 1851380372

  Crossroads Medical Management, Inc.

  CMS ownership

Practitioners 1

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.

• Appavuchetty Soundappan, MD

  • Internal Medicine Physician
  • Perry, GA
  • NPI 1912951500
  NPD (past)

Affiliated clinicians 1

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

• Appavuchetty Soundappan, MD

  • Internal Medicine Physician
  • Perry, GA
  • NPI 1912951500

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1129507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334275200000",
    "number": "1083603609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 MACON RD",
            "address_2": "STE D",
            "city": "PERRY",
            "state": "GA",
            "postal_code": "310692679",
            "telephone_number": "478-988-1294",
            "fax_number": "478-988-1193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 STANLEY ST",
            "city": "PERRY",
            "state": "GA",
            "postal_code": "310693145",
            "telephone_number": "478-987-3100",
            "fax_number": "478-987-0664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMMERHILL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-17",
        "last_updated": "2012-04-13",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "478-988-1294",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "GA",
            "license": "1-076-1106",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000142139B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000142139A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Tina Fairchild Tambornini, LCSW

• Skilled Nursing Facility in Perry, GA
• Providers in Perry, GA by specialty
• Skilled Nursing Facility in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2012; 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.