NPIMap

Organization Active NPI

Belmont Manor Nursing Home Inc

  • Skilled Nursing Facility
  • Belmont, MA
National Provider Identifier
1245218403
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0208 Issued in MA
Legal business name
BELMONT MANOR NURSING HOME INC
Practice address
34 Agassiz Ave
Belmont, MA 02478-5023
Phone
(617) 489-1200
Fax
(617) 489-0855
NPI assigned
Jan 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Patricia R Rullo
Title
Business Manager
Phone
(617) 489-1200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0208 MA Primary

Addresses

Primary practice location

34 Agassiz Ave
Belmont, MA 02478-5023

Mailing address

34 Agassiz Ave
Belmont, MA 02478-5023
Phone (617) 489-1200

Other identifiers 3

IdentifierTypeStateIssuer
0926205MedicaidMA
906653OtherMAHARVARD PILGRIM
2222541901OtherMABLUE CROSS BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150825005428 MA Part A Provider - Skilled Nursing Facility 3779899455 Practice locations: Belmont, MA

Skilled nursing facility certification: CCN 225419

Legal name
BELMONT MANOR NURSING HOME INC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 1, 1990
Last certification
Dec 5, 2024
Beds
156
Ownership / control type
Corporation
Organization structure
CorporationProprietary
Incorporated
Nov 1, 1967 in MA
Enrollment address
34 Agassiz Ave
Belmont, MA 02478-5023
Nursing home name
BELMONT MANOR NURSING HOME, IN

Care Compare: Nursing home

Medicare Care Compare
Listed as
Belmont Manor Nursing Home, inCCN 225419
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jul 1, 1990
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
156125.0 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Locations

34 Agassiz Ave
Belmont, MA 02478
Phone (508) 695-7447

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Susan a. Karger Individual 5% Or Greater Direct Ownership Interest Jan 1, 1976 25%
W-2 Managing EmployeeAdmission Director Jan 1, 1976 25%
Patricia R Rullo Individual Corporate DirectorBusiness Manager Nov 15, 2002
Stewart a. Karger Individual 5% Or Greater Direct Ownership Interest Jun 5, 1979 75%
Corporate OfficerPresident Jun 5, 1979 75%
W-2 Managing EmployeeAdministrator Jun 5, 1979 75%

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 2

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": "1136505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1245218403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34 AGASSIZ AVE",
            "city": "BELMONT",
            "state": "MA",
            "postal_code": "024785023",
            "telephone_number": "617-489-1200",
            "fax_number": "617-489-0855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 AGASSIZ AVE",
            "city": "BELMONT",
            "state": "MA",
            "postal_code": "024785023",
            "telephone_number": "617-489-1200",
            "fax_number": "617-489-0855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELMONT MANOR NURSING HOME INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RULLO",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "617-489-1200"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MA",
            "license": "0208",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0926205",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "906653",
            "state": "MA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "2222541901",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Belmont, MA

Sources for this page

Verify at the official NPI Registry.