NPIMap

Organization Active NPI

Medina BSD Opco LLC

  • Skilled Nursing Facility
  • Medina, OH
National Provider Identifier
1205526324
Registry record updated May 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
MEDINA BSD OPCO LLC
Practice address
550 Miner Dr
Medina, OH 44256-1472
Phone
(330) 725-7550
NPI assigned
May 11, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 11, 2023

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

Authorized official

Name
Mattisyahu Nussbaum
Title
Ceo
Phone
(845) 608-9064

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

550 Miner Dr
Medina, OH 44256-1472

Mailing address

5140 US Highway 9 Ste 1
Howell, NJ 07731-3357

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231108001711 OH Part A Provider - Skilled Nursing Facility 3072973379 Practice locations: Medina, OH

Skilled nursing facility certification: CCN 365774

Legal name
MEDINA BSD OPCO LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 8, 1989
Last certification
Oct 15, 2024
Beds
60
Ownership / control type
Corporation
Multi-facility organization
luxor healthcare group
Organization structure
LLCProprietary
Incorporated
Apr 26, 2023 in OH
Enrollment address
550 Miner Dr
Medina, OH 44256-1472
Nursing home name
MEDINA BSD OPCO LLC

Care Compare: Nursing home

Medicare Care Compare
Listed as
Medina BSD Opco LLCCCN 365774
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Dec 8, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6052.1 residents per day on average
Penalties (3 years)
11Fines totaling $81,720

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

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.

NameRoleSinceShare
Yyam Irrevocable Trust Organization, Jackson, NJ 5% Or Greater Indirect Ownership Interest Jun 23, 2023 94.9%
Mattisyahu Nussbaum Individual 5% Or Greater Indirect Ownership Interest Jun 23, 2023 4.9%
Corporate OfficerManager Jun 23, 2023
Tiffany Wade Individual W-2 Managing EmployeeAdministrator Jun 23, 2023
Operational/Managerial ControlAdministrator Jun 23, 2023
Luxor Healthcare Group LLC Organization, New York, NY LLC Operational/Managerial Control Jun 23, 2023 100%
Medina BSF Opco Holdco LLC Organization, Howell, NJ LLC 5% Or Greater Direct Ownership Interest Jun 23, 2023 100%
Yyam Holdings LLC Organization, New York, NY LLC 5% Or Greater Indirect Ownership Interest Jun 23, 2023 99.9%

Facilities with the same owner 3

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

  • CS Opco LLC
    • Skilled Nursing Facility
    • Warren, OH
    • NPI 1174334635

    Luxor Healthcare Group LLC, Yyam Holdings LLC, Yyam Irrevocable Trust

    CMS ownership
  • Gahana Opco LLC
    • Skilled Nursing Facility
    • Cincinnati, OH
    • NPI 1558051698

    Yyam Holdings LLC, Yyam Irrevocable Trust

    CMS ownership
  • Go Opco LLC
    • Skilled Nursing Facility
    • Dayton, OH
    • NPI 1144038654

    Luxor Healthcare Group LLC, Yyam Holdings LLC, Yyam Irrevocable Trust

    CMS ownership

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 4

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": "1683763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683763200000",
    "number": "1205526324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5140 US HIGHWAY 9 STE 1",
            "city": "HOWELL",
            "state": "NJ",
            "postal_code": "077313357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 MINER DR",
            "city": "MEDINA",
            "state": "OH",
            "postal_code": "442561472",
            "telephone_number": "330-725-7550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDINA BSD OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-11",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-11",
        "status": "A",
        "authorized_official_last_name": "NUSSBAUM",
        "authorized_official_first_name": "MATTISYAHU",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "845-608-9064"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medina, OH

Sources for this page

Verify at the official NPI Registry.