NPIMap

Organization Active NPI

Pine Meadowsidence Opco, LLC

  • Skilled Nursing Facility
  • Lexington, KY
National Provider Identifier
1134545668
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PINE MEADOWSIDENCE OPCO, LLC
Practice address
1608 Hill Rise Dr
Lexington, KY 40504-2503
Phone
(859) 254-2402
NPI assigned
Mar 7, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

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

Authorized official

Name
John Mitchell
Title
Secretary
Phone
(385) 988-3319

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1608 Hill Rise Dr
Lexington, KY 40504-2503

Mailing address

262 N University Ave
Farmington, UT 84025-2975

Other identifiers 1

IdentifierTypeStateIssuer
7100336110MedicaidKY

Other names 1

  • Pine Meadows Post Acute Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140824000077 KY Part A Provider - Skilled Nursing Facility 3870711419 Practice locations: Lexington, KY

Skilled nursing facility certification: CCN 185215

Legal name
PINE MEADOWSIDENCE OPCO LLC
Doing business as
PINE MEADOWS POST ACUTE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 17, 1990
Last certification
Nov 30, 2023
Beds
120
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Feb 3, 2014 in KY
Enrollment address
1608 Hill Rise Dr
Lexington, KY 40504-2503
Nursing home name
PINE MEADOWS POST ACUTE
Affiliated entity
PACS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Pine Meadows Post AcuteCCN 185215
Overall star rating
2 of 5
Health inspections
3 of 5
Staffing
1 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Oct 17, 1990
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
120115.1 residents per day on average
Chain
Pacs Group274 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
18D0665655Pine Meadows Post Acute1608 Hill Rise Dr, Lexington, KY 40504Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Jason H Murray Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%
John T Mitchell Individual Corporate OfficerSecretary Jan 1, 2024
Tanner Tippetts Individual W-2 Managing EmployeeAd; Aug 10, 2020
John W Richard Individual Contracted Managing EmployeeMD; Jan 1, 2015
Frederick G Apt Individual Corporate OfficerTreasurer Jan 1, 2024
Providence Group of Kentucky LLC Organization, Farmington, UT Created for acquisition, LLC, Holding company 5% Or Greater Direct Ownership Interest Feb 3, 2014 100%
Providence Group NH, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Pacs Holdings, LLC Organization, Farmington, UT LLC, Holding company 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Joshua O Jergensen Individual Corporate OfficerPresident Jan 1, 2024
Pacs Group, Inc. Organization, Farmington, UT Corporation, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jun 30, 2023 100%
Mark D Hancock Individual 5% Or Greater Indirect Ownership Interest Apr 15, 2024 41.8%
Corporate OfficerCeo Jan 1, 2024

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 186

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

View all 186

Practitioners & affiliated clinicians

Practitioners 1

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

Affiliated clinicians 1

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": "1394150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724198400000",
    "number": "1134545668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "262 N UNIVERSITY AVE",
            "city": "FARMINGTON",
            "state": "UT",
            "postal_code": "840252975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1608 HILL RISE DR",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405042503",
            "telephone_number": "859-254-2402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE MEADOWSIDENCE OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-07",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "385-988-3319"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100336110",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Meadows Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lexington, KY

Sources for this page

Verify at the official NPI Registry.