Active NPI
Rae-Ann Westlake, Inc.
- Skilled Nursing Facility
- Westlake, OH
National Provider Identifier
1093705717
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 5390
- Legal business name
- RAE-ANN WESTLAKE, INC.
- Practice address
- 28303 Detroit Rd
Westlake, OH 44145-2157 - Phone
- (440) 871-0500
- NPI assigned
- Oct 25, 2005
- Last updated
- Aug 8, 2014
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. John S. Griffiths, LNHA
- Title
- Vice President
- Phone
- (440) 835-3005
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 5390 | OH | Primary |
Addresses
Primary practice location
28303 Detroit Rd
Westlake, OH 44145-2157
Mailing address
PO Box 40175
Bay Village, OH 44140-0175
Phone (440) 835-3005
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0050215 | Medicaid | OH |
Other names 1
- M.A.G., Inc.
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050609000762 | OH | Part A Provider - Skilled Nursing Facility | 2466495486 | Practice locations: Westlake, OH |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1093705717. Details of each certification follow.
Skilled nursing facility certification: CCN 365115
- Legal name
- RAE-ANN WESTLAKE INC
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 1, 1967
- Last certification
- Feb 8, 2024
- Beds
- 130
- Ownership / control type
- Corporation
- Organization structure
- Corporation
- Incorporated
- Jan 3, 1983 in OH
- Enrollment address
- 28303 Detroit Rd
Westlake, OH 44145-2157 - Nursing home name
- RAE-ANN WESTLAKE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Rae-Ann Westlake
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Jan 1, 1967
- Medicare certification status
- Active
- Certified beds
- 130
National Provider Directory
National Provider Directory- Tax ID family
- Mag Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
Locations
28303 Detroit Rd
Westlake, OH 44145
Phone (440) 462-2600
Ownership & related parties
All disclosed owners & managing parties 6
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Dylon Marcum | Corporate Director | May 17, 2022 | |
| Ra Assets Holdco LLC | 5% Or Greater Direct Ownership Interest | May 17, 2022 | 100% |
| Jonathan Gewirtz | 5% Or Greater Indirect Ownership Interest | May 17, 2022 | 12.5% |
| Corporate Officer | May 17, 2022 | ||
| Corporate Director | May 17, 2022 | ||
| W-2 Managing Employee | May 17, 2022 | ||
| Operational/Managerial Control | May 17, 2022 | ||
| Ra Investment Oh LLC | 5% Or Greater Indirect Ownership Interest | May 17, 2022 | 35% |
| Neil Bay Management LLC | Operational/Managerial Control | May 17, 2022 | |
| Ra Opco LLC | 5% Or Greater Indirect Ownership Interest | May 17, 2022 | 52.5% |
Facilities with the same owner 2
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
- Skilled Nursing Facility
- Geneva, OH
- NPI 1437149150
Neil Bay Management LLC, Ra Assets Holdco LLC, Ra Investment Oh LLC, Ra Opco LLC
-
- Skilled Nursing Facility
- Westlake, OH
- NPI 1740270461
Neil Bay Management LLC, Ra Assets Holdco LLC, Ra Investment Oh LLC, Ra Opco LLC
Practitioners & affiliated clinicians
Practitioners 5
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.
-
- Internal Medicine Physician
- Westlake, OH
- NPI 1134111255
-
- Internal Medicine Physician
- Rocky River, OH
- NPI 1073613626
-
- Internal Medicine Physician
- Avon, OH
- NPI 1659363752
-
- Internal Medicine Physician
- Beachwood, OH
- NPI 1225011836
-
- Orthopaedic Surgery Physician
- Boca Raton, FL
- NPI 1407891781
Affiliated clinicians 6
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": "1130198400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1407456000000",
"number": "1093705717",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 40175",
"city": "BAY VILLAGE",
"state": "OH",
"postal_code": "441400175",
"telephone_number": "440-835-3005",
"fax_number": "440-871-3776"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28303 DETROIT RD",
"city": "WESTLAKE",
"state": "OH",
"postal_code": "441452157",
"telephone_number": "440-871-0500"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "RAE-ANN WESTLAKE, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2005-10-25",
"last_updated": "2014-08-08",
"status": "A",
"authorized_official_last_name": "GRIFFITHS",
"authorized_official_first_name": "JOHN",
"authorized_official_middle_name": "S.",
"authorized_official_title_or_position": "VICE PRESIDENT",
"authorized_official_telephone_number": "440-835-3005",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "LNHA"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "OH",
"license": "5390",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0050215",
"state": "OH"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "M.A.G., Inc.",
"code": "4",
"type": "Former Legal Business Name"
}
]
}Other providers in Westlake, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2014; 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.