Active NPI
4800 Bear Road Operating Company LLC
Doing business as Elderwood at Liverpool
- Skilled Nursing Facility
- Liverpool, NY
National Provider Identifier
1285907980
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- 4800 BEAR ROAD OPERATING COMPANY LLC
- Doing business as
- Elderwood at Liverpool
- Practice address
- 4800 Bear Rd
Liverpool, NY 13088-4604 - Phone
- (315) 457-9946
- NPI assigned
- Feb 12, 2012
- Last updated
- Jan 19, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Jeffrey Rubin
- Title
- Co-Chief Executive Officer
- Phone
- (716) 817-5075
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | NU | Primary |
Addresses
Primary practice location
4800 Bear Rd
Liverpool, NY 13088-4604
Mailing address
500 Seneca St Ste 100
Buffalo, NY 14204-1963
Phone (716) 633-3900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 870677 | Medicaid | NY |
Other names 1
- Elderwood at Liverpool
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130122000364 | NY | Part A Provider - Skilled Nursing Facility | 3870746068 | Practice locations: Liverpool, NY |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1285907980. Details of each certification follow.
Skilled nursing facility certification: CCN 335678
- Legal name
- 4800 BEAR ROAD OPERATING COMPANY, LLC
- Doing business as
- ELDERWOOD AT LIVERPOOL
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Dec 31, 1984
- Last certification
- Feb 27, 2024
- Beds
- 160
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC
- Incorporated
- Oct 12, 2011 in NY
- Enrollment address
- 4800 Bear Rd
Liverpool, NY 13088-4604 - Nursing home name
- ELDERWOOD AT LIVERPOOL
- Affiliated entity
- ELDERWOOD
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Elderwood at Liverpool
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Dec 31, 1984
- Medicare certification status
- Active
- Certified beds
- 160
- Chain
- Elderwood
- Penalties (3 years)
- 1
National Provider Directory
National Provider Directory- Tax ID family
- 4800 Bear Road Operating Company LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Long Term Care Pharmacy
- Liverpool, NY
- NPI 1316370091
Locations
4800 Bear Rd
Liverpool, NY 13088
Phone (315) 391-6645
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.
| Name | Role | Since | Share |
|---|---|---|---|
| Philip Quillard | Contracted Managing Employee | Aug 9, 2019 | |
| Cherlyn Mary Deleonabreu | W-2 Managing Employee | Apr 26, 2021 | |
| Kimberly a Kenworthy | Contracted Managing Employee | Aug 9, 2019 | |
| Jeffrey Rubin | 5% Or Greater Direct Ownership Interest | Oct 12, 2011 | 50% |
| Corporate Officer | Oct 12, 2011 | 50% | |
| Operational/Managerial Control | Oct 12, 2011 | 50% | |
| Warren D Cole | 5% Or Greater Direct Ownership Interest | Oct 12, 2011 | 50% |
| Corporate Officer | Oct 12, 2011 | 50% | |
| Operational/Managerial Control | Oct 12, 2011 | 50% | |
| John Paul S Vinkle | Contracted Managing Employee | Aug 9, 2019 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Family Nurse Practitioner
- Liverpool, NY
- NPI 1750108825
W-2 Managing Employee
Subparts reporting this organization as parent 1
Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.
-
- Long Term Care Pharmacy
- Liverpool, NY
- NPI 1316370091
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.
-
- Family Medicine Physician
- Fayetteville, NY
- NPI 1487614988
-
- Family Medicine Physician
- Syracuse, NY
- NPI 1154909752
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": "1329004800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1674086400000",
"number": "1285907980",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 SENECA ST STE 100",
"city": "BUFFALO",
"state": "NY",
"postal_code": "142041963",
"telephone_number": "716-633-3900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4800 BEAR RD",
"city": "LIVERPOOL",
"state": "NY",
"postal_code": "130884604",
"telephone_number": "315-457-9946"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "4800 BEAR ROAD OPERATING COMPANY LLC",
"organizational_subpart": "NO",
"enumeration_date": "2012-02-12",
"last_updated": "2023-01-19",
"certification_date": "2023-01-19",
"status": "A",
"authorized_official_last_name": "RUBIN",
"authorized_official_first_name": "JEFFREY",
"authorized_official_title_or_position": "CO-CHIEF EXECUTIVE OFFICER",
"authorized_official_telephone_number": "716-817-5075",
"authorized_official_name_prefix": "Dr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "870677",
"state": "NY"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Elderwood at Liverpool",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Elderwood at Liverpool",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Liverpool, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2023; 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.