NPIMap

Organization Active NPI

Bridgewater Park LLC

Doing business as Bridgewater Park Health & Rehabilitation Center

  • Skilled Nursing Facility
  • Ocala, FL
National Provider Identifier
1225577505
Registry record updated Jan 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
BRIDGEWATER PARK LLC
Doing business as
Bridgewater Park Health & Rehabilitation Center
Practice address
9280 SW 81St CT
Ocala, FL 34481
Phone
(352) 509-5201
Fax
(352) 861-4255
NPI assigned
Feb 20, 2017
Last updated
Jan 7, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2021

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

Authorized official

Name
Mr. Cullen S Gibson
Title
Vice President
Phone
(765) 664-5400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X FL Primary

Addresses

Primary practice location

9280 SW 81St CT
Ocala, FL 34481

Mailing address

1800 N Wabash Rd
Marion, IN 46952-1300
Phone (765) 664-5400

Other identifiers 1

IdentifierTypeStateIssuer
0229220-00MedicaidFL

Other names 1

  • BRIDGEWATER PARK HEALTH & REHABILITATION CENTER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170717002463 FL Part A Provider - Skilled Nursing Facility 8921378472 Practice locations: Ocala, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225577505. Details of each certification follow.

Skilled nursing facility certification: CCN 106115

Legal name
BRIDGEWATER PARK LLC
Doing business as
BRIDGEWATER PARK HEALTH & REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 30, 2017
Last certification
Sep 6, 2024
Beds
120
Ownership / control type
Limited Liability Corporation
Multi-facility organization
TLC Management
Organization structure
LLCProprietary
Incorporated
Oct 16, 2014 in FL
Enrollment address
9280 SW 81St CT
Ocala, FL 34481-7848
Nursing home name
BRIDGEWATER PARK HEALTH & REHABILITATION CENTER
Affiliated entity
TLC MANAGEMENT

Care Compare: Nursing home

Medicare Care Compare
Listed as
Bridgewater Park Health & Rehabilitation CenterCCN 106115 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Nov 30, 2017
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
120116.4 residents per day on average
Chain
TLC Management20 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Locations

1800 N Wabash Rd
Ste 300
Marion, IN 46952
Phone (765) 651-3242

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)

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Ryan Ott Individual 5% Or Greater Direct Ownership InterestMember Oct 16, 2014 23%
Corporate OfficerPresident Oct 16, 2014 23.05%
Adp of the SNF Oct 16, 2014
Direct Ownership Interest Jun 28, 2017 23.05%
Cullen S Gibson Individual 5% Or Greater Direct Ownership InterestVice President Oct 16, 2014 4.99%
Corporate OfficerVice President Oct 16, 2017 4.99%
Adp of the SNF Oct 16, 2014
Direct Ownership Interest Jun 28, 2017 4.99%
Gary L Ott Individual 5% Or Greater Direct Ownership InterestPresident Oct 16, 2014 53%
Corporate OfficerChairman of the Board Oct 16, 2014 53.2%
Adp of the SNF Oct 16, 2014
Direct Ownership Interest Jun 28, 2017 53.2%
Dwight a Ott Individual 5% Or Greater Direct Ownership InterestSecretary/Treasurer Oct 16, 2014 9.5%
Corporate OfficerSecretary/Treasurer Oct 16, 2014 9.5%
Adp of the SNF Oct 16, 2014
Direct Ownership Interest Jun 28, 2017 9.5%
Sidney E Clevinger Individual Operational/Managerial Control Apr 1, 2014
Adp of the SNF Feb 15, 2014
Tender Loving Care Management Inc Organization, Marion, IN Corporation, Management services company Operational/Managerial Control Jun 1, 2017 100%
Adp of the SNF Mar 10, 2025
Joseph R Wanczyk Individual Operational/Managerial Control Mar 7, 2022
Adp of the SNF Mar 7, 2022

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 19

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

View all 19

Practitioners & affiliated clinicians

Practitioners 2

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 8

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": "1487548800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609977600000",
    "number": "1225577505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 N WABASH RD",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469521300",
            "telephone_number": "765-664-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9280 SW 81ST CT",
            "city": "OCALA",
            "state": "FL",
            "postal_code": "34481",
            "telephone_number": "352-509-5201",
            "fax_number": "352-861-4255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRIDGEWATER PARK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-20",
        "last_updated": "2021-01-07",
        "certification_date": "2021-01-07",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "CULLEN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "765-664-5400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0229220-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BRIDGEWATER PARK HEALTH & REHABILITATION CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BRIDGEWATER PARK HEALTH & REHABILITATION CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ocala, FL

Sources for this page

Verify at the official NPI Registry.