CCRC of West Des Moines, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CCRC OF WEST DES MOINES, LLC

Doing business as

Cedar Ridge Village

Practice address

8950 Coachlight Drive
West Des Moines, IA 50266

Phone

(515) 369-2100

Fax

(913) 956-6564

NPI assigned

Dec 12, 2018

Last updated

Dec 12, 2018By 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

Scott Gulledge

Title

Manager by Contract

Phone

(913) 890-4780

Specialties & licenses 1

Addresses

Other names 1

• Cedar Ridge Village Doing business as

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093286395. Details of each certification follow.

• CCN 165790 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 165790

Legal name

CCRC OF WEST DES MOINES LLC

Doing business as

CEDAR RIDGE VILLAGE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Aug 30, 2021

Last certification

Aug 1, 2024

Beds

40

Ownership / control type

Corporation

Multi-facility organization

Pivotal Health Care

Organization structure

LLCProprietary

Enrollment address

8950 Coachlight Dr
West Des Moines, IA 50266-8778

Nursing home name

CEDAR RIDGE VILLAGE

Affiliated entity

PIVOTAL HEALTH CARE

Listed as

Cedar Ridge VillageCCN 165790 · All quality measures

Overall star rating

3 of 5

Health inspections

3 of 5

Staffing

4 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Aug 30, 2021

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

4038.8 residents per day on average

Chain

Pivotal Health Care9 facilities in the chain

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Central Iowa Hospital Corporation

  dba Iowa Lutheran Hospital

  • General Acute Care Hospital
  • Des Moines, IA
  • NPI 1356433049

  Member Of

  NPD member

All disclosed owners & managing parties 42

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 10

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

• Central Iowa Hospital Corporation

  dba IMMC Outpatient Pharmacy

  • Pharmacy
  • Des Moines, IA
  • NPI 1003352949

  Direct Ownership Interest

  CMS ownership
• Central Iowa Hospital Corporation

  dba Iowa Methodist Medical Center

  • Rehabilitation Hospital Unit
  • Des Moines, IA
  • NPI 1003908666

  Direct Ownership Interest

  CMS ownership
• Central Iowa Hospital Corporation

  dba Iowa Lutheran Hospital

  • Psychiatric Hospital Unit
  • Des Moines, IA
  • NPI 1033201793

  Direct Ownership Interest

  CMS ownership
• Central Iowa Hospital Corporation

  dba East Des Moines Family Care Center

  • Family Medicine Physician
  • Des Moines, IA
  • NPI 1104879576

  Direct Ownership Interest

  CMS ownership
• Central Iowa Hospital Corporation

  dba Iowa Methodist Medical Center

  • General Acute Care Hospital
  • Des Moines, IA
  • NPI 1396837951

  Direct Ownership Interest

  CMS ownership
• Central Iowa Hospital Corporation

  dba Pathology Laboratory

  • Clinical Medical Laboratory
  • Ankeny, IA
  • NPI 1962485136

  Direct Ownership Interest

  CMS ownership
• Iowa Physicians Clinic Medical Foundation

  dba UnityPoint Clinic

  • General Practice Physician
  • West Des Moines, IA
  • NPI 1366425274

  Adp of the SNF

  CMS ownership
• Iowa Physicians Clinic Medical Foundation

  dba Unitypoint Clinic Laboratory Prairie Parkway

  • Clinical Medical Laboratory
  • Cedar Falls, IA
  • NPI 1538617840

  Adp of the SNF

  CMS ownership
• Michael P O'Conner, DO

  • Internal Medicine Physician
  • Des Moines, IA
  • NPI 1396724167

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Summit Care, LLC

  • Physical Therapist
  • Overland Park, KS
  • NPI 1033441027

  Adp of the SNF

  CMS ownership

Facilities with the same owner 9

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

• CCRC of Altoona LLC

  dba Prairie Vista Village

  • Skilled Nursing Facility
  • Altoona, IA
  • NPI 1558799031

  Pivotal Health Care LLC, Scenic Development LLC

  CMS ownership
• CCRC of Ames LLC

  dba Northridge Village

  • Skilled Nursing Facility
  • Ames, IA
  • NPI 1316322704

  Pivotal Health Care LLC, Scenic Development LLC

  CMS ownership
• CCRC of Grimes, LLC

  dba Kennybrook Village

  • Skilled Nursing Facility
  • Grimes, IA
  • NPI 1013200914

  Pivotal Health Care LLC, Scenic Development LLC

  CMS ownership
• CCRC of Cedar Rapids, LLC

  dba Terrace Glen Village

  • Skilled Nursing Facility
  • Overland Park, KS
  • NPI 1972041952

  Pivotal Health Care LLC, Scenic Development LLC

  CMS ownership
• CCRC of Gladstone, LLC

  dba Linden Woods Village

  • Skilled Nursing Facility
  • Gladstone, MO
  • NPI 1033579578

  Pivotal Health Care LLC, Scenic Development LLC

  CMS ownership
• CCRC of Lees Summit, LLC

  dba Raintree Village

  • Skilled Nursing Facility
  • Lee's Summit, MO
  • NPI 1205528353

  Pivotal Health Care LLC, Scenic Development LLC

  CMS ownership
• CCRC of Lenexa, LLC

  dba Westchester Village of Lenexa

  • Skilled Nursing Facility
  • Lenexa, KS
  • NPI 1144734088

  Pivotal Health Care LLC, Scenic Development LLC

  CMS ownership
• CCRC of Overland Park, LLC

  dba Colonial Village

  • Skilled Nursing Facility
  • Overland Park, KS
  • NPI 1063946143

  Pivotal Health Care LLC, Scenic Development LLC

  CMS ownership
• Corterra of Wichita, LLC

  • Psychiatric Hospital
  • Wichita, KS
  • NPI 1245949684

  Scenic Development LLC

  CMS ownership

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

{
    "created_epoch": "1544572800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544572800000",
    "number": "1093286395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11827 W 112TH ST STE 103",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662102718",
            "telephone_number": "913-890-4780",
            "fax_number": "913-956-6564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8950 COACHLIGHT DRIVE",
            "city": "WEST DES MOINES",
            "state": "IA",
            "postal_code": "50266",
            "telephone_number": "515-369-2100",
            "fax_number": "913-956-6564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCRC OF WEST DES MOINES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-12",
        "last_updated": "2018-12-12",
        "status": "A",
        "authorized_official_last_name": "GULLEDGE",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_title_or_position": "MANAGER BY CONTRACT",
        "authorized_official_telephone_number": "913-890-4780"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cedar Ridge Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Cassie Leutzinger, Psy.D., LLC
• Barbara Ann Cassler, RN
• Catholic Health Initiatives - Iowa Corp (MercyOne West Des Moines Medical Center)
• Catholic Health Initiatives-Iowa Corp (MercyOne Iowa Heart Center)
• Arijana Catic
• Megan Cecil
• Cecilia's Home, LLC
• Roger I Ceilley, M.D.
• Center Path Psychotherapy, PLLC
• Central Iowa Dermatology LLC

• Skilled Nursing Facility in West Des Moines, IA
• Providers in West Des Moines, IA by specialty
• Skilled Nursing Facility in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2018; 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.