NPIMap

Organization Active NPI

Shreveport Rehabilitation Hospital, LLC

  • Rehabilitation Hospital
  • Shreveport, LA
National Provider Identifier
1154956241
Registry record updated Nov 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation HospitalTaxonomy code 283X00000X
Legal business name
SHREVEPORT REHABILITATION HOSPITAL, LLC
Practice address
1451 Fern Circle
Shreveport, LA 71105-7501
Phone
(469) 640-6503
NPI assigned
Mar 9, 2020
Last updated
Nov 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2024

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

Authorized official

Name
Tracey Nixon
Title
Chief Compliance Officer
Phone
(469) 640-6503

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital 283X00000X Primary

Addresses

Primary practice location

1451 Fern Circle
Shreveport, LA 71105-7501

Mailing address

450 Century Pkwy Ste 220
Allen, TX 75013-8135
Phone (469) 640-6503

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler Other CMS HIH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211008002786 LA Part A Provider - Hospital 5092113837 Practice locations: Shreveport, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154956241. Details of each certification follow.

Hospital certification: CCN 713029

Legal name
SHREVEPORT REHABILITATION HOSPITAL, LLC
Doing business as
SHREVEPORT REHABILITATION HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Rehabilitation
Participating since
Feb 18, 2022
Last certification
Feb 18, 2025
Beds
40
Ownership / control type
Private (for profit)
Organization structure
LLCProprietary
Enrollment address
1451 Fern Cir
Shreveport, LA 71105-4177
Main/Primary Hospital Location
Hospital subgroups
Rehabilitation

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Shreveport Rehabilitation Hospital LLCCCN 713029 · All quality measures
Ownership
For profit
Certified
Feb 18, 2022
Medicare certification status
ActiveFrom the Provider of Services file

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
19D2237811Shreveport Rehabilitation Hospital, LLC1451 Fern Circle, Shreveport, LA 71105Certificate of waiverSep 27, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Tracey Nixon Individual Corporate OfficerChief Compliance Officer Sep 13, 2021
Nepi, LLC Organization, Grapevine, TX LLC 5% Or Greater Indirect Ownership Interest Apr 26, 2023 6%
Daryn Eudaly Individual 5% Or Greater Indirect Ownership Interest Jul 28, 2025 27.21%
Alex Bennett Individual 5% Or Greater Indirect Ownership Interest Apr 26, 2023 8.39%
Nesi, LLC Organization, Grapevine, TX LLC 5% Or Greater Indirect Ownership Interest Apr 26, 2023 6%
SPC Capital, Inc. Organization, Grapevine, TX Corporation 5% Or Greater Indirect Ownership Interest Jul 28, 2025 27.21%
Russell Martin Individual W-2 Managing EmployeeChief Executive Officer Dec 12, 2022
New Era Companies, LLC Organization, Grapevine, TX LLC 5% Or Greater Indirect Ownership Interest Jul 28, 2025 54.42%
Nec Rhi, LLC Organization, Grapevine, TX LLC 5% Or Greater Indirect Ownership Interest Apr 26, 2023 27.59%
WB Development Holdings, LLC Organization, Dallas, TX LLC 5% Or Greater Indirect Ownership Interest Apr 26, 2023 33.58%
Nobis Rehabilitation Partners, LLC Organization, Lucas, TX LLC Operational/Managerial Control Sep 15, 2021 100%
Newera Nobis Operations Holdings, LLC Organization, Grapevine, TX LLC 5% Or Greater Direct Ownership Interest Sep 15, 2021 100%
Nobis Hospital Investments, LLC Organization, Lucas, TX LLC 5% Or Greater Indirect Ownership Interest Sep 15, 2021 6%
Ahac Investments, LLC Organization, Irving, TX LLC 5% Or Greater Indirect Ownership Interest Apr 26, 2023 8.39%
Newera Irf Holdings, LLC Organization, Grapevine, TX LLC 5% Or Greater Indirect Ownership Interest Apr 26, 2023 100%
Karen Macy Schepis Individual Corporate DirectorCorporate Director of Compliance May 20, 2023
Nobis Rehabilitation Holdings, LLC Organization, Lucas, TX LLC 5% Or Greater Indirect Ownership Interest Apr 26, 2023 6%
Margie Crawley Individual Corporate DirectorCorporate Director of Rev Cycle May 20, 2023
Chester W Crouch Individual Corporate OfficerPresident Sep 13, 2021
Irf JV Investors, LLC Organization, Grapevine, TX LLC 5% Or Greater Indirect Ownership Interest Apr 26, 2023 6%

Facilities with the same owner 15

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

View all 15

Practitioners & affiliated clinicians

Practitioners 3

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.

Affiliated clinicians 7

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": "1583712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732492800000",
    "number": "1154956241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 CENTURY PKWY STE 220",
            "city": "ALLEN",
            "state": "TX",
            "postal_code": "750138135",
            "telephone_number": "469-640-6503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1451 FERN CIRCLE",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711057501",
            "telephone_number": "469-640-6503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHREVEPORT REHABILITATION HOSPITAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-09",
        "last_updated": "2024-11-25",
        "certification_date": "2024-11-25",
        "status": "A",
        "authorized_official_last_name": "NIXON",
        "authorized_official_first_name": "TRACEY",
        "authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER",
        "authorized_official_telephone_number": "469-640-6503"
    },
    "taxonomies": [
        {
            "code": "283X00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.13.34.110.1.998.01",
            "affiliationName": "CMS HIH",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "7500 Security Blvd",
            "city": "Baltimore",
            "state": "MD",
            "country_code": "US",
            "postal_code": "212441849",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

Verify at the official NPI Registry.