NPIMap

Organization Active NPI

Bethesda Long Term Care, Inc

  • Skilled Nursing Facility
  • Saint Louis, MO
National Provider Identifier
1114993391
Registry record updated May 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
031349 Issued in MO
Legal business name
BETHESDA LONG TERM CARE, INC
Practice address
9645 Big Bend Blvd
Saint Louis, MO 63122-6521
Phone
(314) 968-5460
Fax
(314) 800-1961
NPI assigned
Feb 27, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2025

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

Authorized official

Name
Roger Byrne
Title
Cfo
Phone
(314) 800-1955

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 031349 MO Primary

Addresses

Primary practice location

9645 Big Bend Blvd
Saint Louis, MO 63122-6521

Mailing address

12101 Woodcrest Executive Dr Ste 200
Saint Louis, MO 63141-5047
Phone (314) 800-1900

Other identifiers 1

IdentifierTypeStateIssuer
101480309MedicaidMO

Other names 1

  • Bethesda Dilworth Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071023000239 MO Part A Provider - Skilled Nursing Facility 9436068772 Practice locations: Saint Louis, MO

Skilled nursing facility certification: CCN 265764

Legal name
BETHESDA LONG TERM CARE INC
Doing business as
BETHESDA DILWORTH
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
May 1, 2003
Last certification
Sep 29, 2023
Beds
400 (350 certified)
Ownership / control type
Nonprofit Corporation
Multi-facility organization
BETHESDA HEALTH GROUP
Organization structure
CorporationNon-profit
Enrollment address
9645 Big Bend Blvd
Saint Louis, MO 63122-6521
Nursing home name
BETHESDA DILWORTH

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Bethesda DilworthCCN 265764
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
May 1, 2003
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
350128.0 residents per day on average
Penalties (3 years)
1Fines totaling $88,946

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Bethesda Gen Hosp Homes5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

12101 Woodcrest Executive Dr
Ste 200
Saint Louis, MO 63141
Phone (314) 800-1900

Ownership & related parties

All disclosed owners & managing parties 24

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

NameRoleSinceShare
James Esther Individual Corporate DirectorDirector Jan 1, 2018
Managing Control - Governing BodyDirector Jan 1, 2018
Scott M Dembiec Individual Operational/Managerial Control Mar 1, 2025
Adp of the SNF Mar 1, 2025
Joseph J. Brinker Individual Corporate OfficerPresident and Ceo Jul 10, 2010
Corporate DirectorPresident and Ceo Jul 1, 2010
Operational/Managerial Control Jul 1, 2010
Managing Control - Governing BodyPresident and Ceo Jul 1, 2010
Adp of the SNF Jul 1, 2010
Individual Adp of the SNF Apr 1, 2025
Joseph Keller Individual Corporate DirectorDirector Jan 1, 2019
Managing Control - Governing Body Jan 1, 2019
Patrick J. Rooney Individual Corporate Officer Jan 1, 2026
Managing Control - Governing Body Jan 1, 2021
Gary Mayes Individual Corporate DirectorDirector Jan 1, 2023
Managing Control - Governing Body Jan 1, 2023
John Dale Meier Individual Corporate Officer Jan 1, 2019
Managing Control - Governing Body Jan 1, 2019
Roger Byrne Individual Corporate OfficerChief Financial Officer Feb 10, 2014
Operational/Managerial Control Feb 10, 2014
Managing Control - Governing Body Feb 10, 2014
Adp of the SNF Feb 10, 2014
John W. Rowe Individual Corporate Director Jan 1, 2025
Managing Control - Governing Body Jan 1, 2025
Kiel Peregrin Individual Corporate OfficerChief Operating Officer Feb 23, 2020
Operational/Managerial Control Feb 23, 2020
Managing Control - Governing Body Feb 23, 2020
Adp of the SNF Feb 23, 2020
Bethesda Health Group Inc Organization, Saint Louis, MO Corporation, Non-profit, Chain home office Operational/Managerial Control Jul 8, 1999
Adp of the SNF Sep 2, 2025
Organization, Charlotte, NC Corporation, Financial institution, For-profit Adp of the SNF Jul 10, 2025
Jessica McIntosh Individual Operational/Managerial Control Feb 10, 2025
Adp of the SNF Feb 10, 2025
Kevin Klingler Individual Corporate Officer Jan 1, 2024
Managing Control - Governing Body Jan 1, 2024
Philip Hutchison Individual Corporate Officer Jan 1, 2020
Managing Control - Governing Body Jan 1, 2020
Veronica F McDonnell Individual Corporate Director Apr 25, 2025
Managing Control - Governing BodyCorporate Director Apr 25, 2025
Jennifer Popp Individual Operational/Managerial Control Jan 31, 2025
Adp of the SNF Jan 31, 2025
Fred G. Falker Individual Corporate DirectorDirector Jan 1, 2022
Managing Control - Governing Body Jan 1, 2022
Select Rehabilitation, LLC Organization, Glenview, IL LLC, Medical staffing company Operational/Managerial Control Dec 15, 2015
Adp of the SNF Jul 10, 2025
Renee Cwiklowski Individual Operational/Managerial Control May 4, 2023
Adp of the SNF May 4, 2023
Bethesda Long Term Care Inc Organization, Saint Louis, MO Corporation, Non-profit 5% Or Greater Direct Ownership Interest Apr 1, 2006 100%
Adp of the SNF Apr 1, 2006
Direct Ownership Interest Apr 1, 2006 100%
Samantha Teibel Individual Corporate Director Feb 27, 2025
Managing Control - Governing Body Feb 27, 2025
Michele Kimball Individual Operational/Managerial Control Feb 21, 2021
Adp of the SNF Feb 21, 2021

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Bethesda SouthgateSaint Louis, MO, CCN 265756 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 Jun 30, 2000
Jun 30, 2000

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 14

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

View all 14

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 3

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": "1140998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748390400000",
    "number": "1114993391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12101 WOODCREST EXECUTIVE DR STE 200",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631415047",
            "telephone_number": "314-800-1900",
            "fax_number": "314-900-3683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9645 BIG BEND BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631226521",
            "telephone_number": "314-968-5460",
            "fax_number": "314-800-1961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHESDA LONG TERM CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-27",
        "last_updated": "2025-05-28",
        "certification_date": "2025-05-28",
        "status": "A",
        "authorized_official_last_name": "BYRNE",
        "authorized_official_first_name": "ROGER",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "314-800-1955"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "031349",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101480309",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bethesda Dilworth",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.