Indian River Center, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF1348096 Issued in FL

Legal business name

INDIAN RIVER CENTER, LLC

Doing business as

Indian River Center

Practice address

7201 Greenboro Dr
West Melbourne, FL 32904-1698

Phone

(321) 727-0990

Fax

(321) 951-4553

NPI assigned

Oct 13, 2005

Last updated

Feb 27, 2024By 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

Mrs. Monica Terrano

Title

Chief Financial Officer

Phone

(819) 852-7000

Specialties & licenses 1

Addresses

Other identifiers 6

Other names 1

• Indian River Center Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164410197. Details of each certification follow.

• CCN 105673 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 105673

Legal name

INDIAN RIVER CENTER, LLC

Doing business as

INDIAN RIVER CENTER

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Aug 29, 1989

Last certification

Sep 13, 2024

Beds

179

Ownership / control type

Corporation

Multi-facility organization

Citadel Care Centers

Most recent change of ownership

May 1, 2003

Organization structure

LLCProprietary

Enrollment address

7201 Greenboro Dr
West Melbourne, FL 32904-1698

Nursing home name

INDIAN RIVER CENTER

Affiliated entity

ASTON HEALTH

Listed as

Indian River CenterCCN 105673 · All quality measures

Overall star rating

2 of 5

Health inspections

2 of 5

Staffing

4 of 5

Quality measures

2 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Aug 29, 1989

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

179169.4 residents per day on average

Chain

Aston Health38 facilities in the chain

Penalties (3 years)

1Fines totaling $74,386

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

Networks

• Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
• Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

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.

Owners & managing parties with NPI records 1

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

• Gaurang B. Patel, M.D

  • Internal Medicine Physician
  • Palm Bay, FL
  • NPI 1366739773

  Adp of the SNF

  CMS ownership

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Gabriel E Cueto, MD

  • Hospitalist Physician
  • Palm Bay, FL
  • NPI 1356578629

  Nursing home

  Care Compare affiliation
• Aravind K Kumar, MD

  • Internal Medicine Physician
  • West Melbourne, FL
  • NPI 1871539072

  Nursing home

  Care Compare affiliation
• Gaurang B. Patel, M.D

  • Internal Medicine Physician
  • Palm Bay, FL
  • NPI 1366739773

  Nursing home

  Care Compare affiliation
• John H Potomski Jr., DO CMA

  • Geriatric Medicine (Internal Medicine) Physician
  • Melbourne, FL
  • NPI 1083657183

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708992000000",
    "number": "1164410197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7201 GREENBORO DR",
            "city": "WEST MELBOURNE",
            "state": "FL",
            "postal_code": "329041698",
            "telephone_number": "321-727-0990",
            "fax_number": "321-951-4553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7201 GREENBORO DR",
            "city": "WEST MELBOURNE",
            "state": "FL",
            "postal_code": "329041698",
            "telephone_number": "321-727-0990",
            "fax_number": "321-951-4553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIAN RIVER CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-13",
        "last_updated": "2024-02-27",
        "certification_date": "2024-02-27",
        "status": "A",
        "authorized_official_last_name": "TERRANO",
        "authorized_official_first_name": "MONICA",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "819-852-7000",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1348096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0005900226",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "K3M",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE HH CONNECTION",
            "identifier": "70-00474",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED AMERICAN",
            "identifier": "C105673",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "026066500",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MI",
            "identifier": "08845",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Indian River Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in West Melbourne, FL
• Providers in West Melbourne, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2024; 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.