Delmar Gardens of Overland Park Operating, LLC
Organization Active NPI Skilled Nursing Facility · Overland Park, KS
NPI 1285629048 · NPPES record last updated Jan 22, 2015
Key facts
- NPI
- 1285629048
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- N046032 (KS)
- Legal business name
- DELMAR GARDENS OF OVERLAND PARK OPERATING, LLC
- Practice address
- 12100 W 109TH St
Overland Park, KS 66210-1200 - Phone
- (913) 469-4210
- Fax
- (913) 469-0136
- NPI assigned
- Sep 16, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. Gail Lee Hartmann
- Title
- Treasurer
- Phone
- (636) 733-7000
Owners & managing parties with NPI records 1
Facilities with the same owner 16
Practitioners 4
-
Ammar Khalifa, MD
-
Louay K. Sabih, M.D.
-
Emily S Worthington, D.O.
Affiliated clinicians 3
-
Ammar Khalifa, MD
-
Louay K. Sabih, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Delmar Gardens of Overland Park
- Overall star rating
- ★★★☆☆ 3 of 5
- Health inspections
- ★★★☆☆ 3 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Mar 20, 1989
- Medicare certification status
- Active
- Certified beds
- 120 · 100.2 residents per day on average
- Chain
- Delmar Gardens
- Penalties (3 years)
- 4 · fines totaling $23,261
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 17D0449340 | Delmar Gardens of Overland Park | Certificate of waiver | Jun 4, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Skilled nursing facility certification: CCN 175182
- Legal name
- DELMAR GARDENS OF OVERLAND PARK OPERATING LLC
- Doing business as
- DELMAR GARDENS OF OVERLAND PARK
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF distinct part
- Participating since
- Mar 20, 1989
- Last certification
- Mar 13, 2024
- Beds
- 120
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Delmar Gardens Enterprises
- Organization structure
- LLC · Proprietary
- Incorporated
- Mar 11, 2003 in KS
- Enrollment address
- 12100 W 109TH St
Overland Park, KS 66210-1200 - Nursing home name
- DELMAR GARDENS OF OVERLAND PARK
- Affiliated entity
- DELMAR GARDENS
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Janice G Bitansky |
Other |
Nov 30, 2010 | 4.26% |
| Harry Z Goldberg |
Other |
Nov 30, 2010 | 4.26% |
| Non-Gstfamily Trust Est U/W Israel Goldberg Fbo Diane Fredman |
5% Or Greater Indirect Ownership Interest | Apr 10, 2013 | 5.71% |
| Gabe Grossberg and George Grossberg, Trustees of the Henry and Barbara |
5% Or Greater Indirect Ownership Interest | Mar 11, 2003 | 8.04% |
| Delmar Gardens Management Services Inc |
Operational/Managerial Control | Apr 1, 2005 | 100% |
| Delmar Gardens Enterprises Inc |
5% Or Greater Direct Ownership Interest | Mar 11, 2003 | 100% |
| Diane G Fredman |
Other |
Nov 30, 2010 | 4.26% |
| Gabe Grossberg |
5% Or Greater Indirect Ownership Interest | Mar 11, 2003 | 16.33% |
| Corporate Officer |
Mar 11, 2003 | ||
| Other |
Mar 11, 2003 | ||
| Goldberg-Nom LLC |
5% Or Greater Indirect Ownership Interest | Mar 11, 2003 | 25% |
| George T Grossberg |
5% Or Greater Indirect Ownership Interest | Mar 11, 2003 | 11.33% |
| Other |
Mar 11, 2003 | ||
| Non-GST Family Trust Est U/W of Israel Goldberg Fbo Janice Bitanski |
5% Or Greater Indirect Ownership Interest | Apr 10, 2013 | 5.71% |
| Tammy Conekin |
W-2 Managing Employee |
Jul 10, 2023 | |
| Howard M Oppenheimer |
Corporate Officer |
Mar 11, 2003 | |
| Other |
Mar 11, 2003 | ||
| Kenneth F Marx |
Corporate Officer |
Jun 11, 2019 | |
| Amanda Hill |
W-2 Managing Employee |
Sep 10, 2021 | |
| George Grossberg and Gabe Grossberg, Trustees of the Henry and Barbara |
5% Or Greater Indirect Ownership Interest | Mar 11, 2003 | 8.04% |
| Non-GST Family Trust Established U/W of Israel Goldberg Fbo Harry Zvi |
5% Or Greater Indirect Ownership Interest | Apr 10, 2013 | 5.71% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050309000811 | KS | Part a Provider - Skilled Nursing Facility | 9436103728 | Practice locations: Overland Park, KS |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | N046032 | KS | Yes |
Addresses
Primary practice location
12100 W 109TH St
Overland Park, KS 66210-1200
Mailing address
14805 N Outer 40 Rd
Suite 300
Chesterfield, MO 63017-6060
Phone (636) 733-7000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200317320-A | Medicaid | KS |
Other names
- Delmar Gardens of Overland Park
Other providers in Overland Park, KS
- Jareth Del Real
- Kristina R Delacruz
- Joan Ziegler Delahunt
- Marie A Delcambre
- Alison Nicole Delich
- Courtney K Delong
- Patricia Demarco
- Deena Dement
- Demint Anesthesia Services, LLC
- Brenda E. Demint
All providers in Overland Park, KS · Skilled Nursing Facility in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 22, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.