Active NPI
Sovereign Healthcare of Pinellas Point, LLC
- Skilled Nursing Facility
- St Petersburg, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- SNF16060961
- Legal business name
- SOVEREIGN HEALTHCARE OF PINELLAS POINT, LLC
- Practice address
- 5601 31St St S
St Petersburg, FL 33712-4605 - Phone
- (727) 867-6955
- Fax
- (727) 867-1824
- NPI assigned
- Sep 29, 2005
- 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
- Mr. R. Mark Cronquist
- Title
- Manager
- Phone
- (404) 574-2100
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | SNF16060961 | FL | Primary |
Addresses
Primary practice location
5601 31St St S
St Petersburg, FL 33712-4605
Mailing address
5887 Glenridge Dr
Suite 150
Atlanta, GA 30328-5574
Phone (404) 574-2100
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| V516P-6821 | Other | VA | |
| 026348600 | Medicaid | FL |
Other names 1
- Pinellas Point Nursing & Rehab Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030909000029 | FL | Part A Provider - Skilled Nursing Facility | 5193636413 | Practice locations: St Petersburg, FL |
Skilled nursing facility certification: CCN 105878
- Legal name
- SOVEREIGN HEALTHCARE OF PINELLAS POINT LLC
- Doing business as
- PINELLAS POINT NURSING AND REHAB CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Mar 8, 1995
- Last certification
- May 1, 2024
- Beds
- 60
- Ownership / control type
- Corporation
- Multi-facility organization
- Sovereign
- Most recent change of ownership
- Oct 1, 2003
- Organization structure
- LLC
- Enrollment address
- 5601 31St St S
St Petersburg, FL 33712-4605 - Nursing home name
- PINELLAS POINT NURSING AND REHAB CENTER
- Affiliated entity
- SOVEREIGN HEALTHCARE HOLDINGS
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Pinellas Point Nursing and Rehab Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Mar 8, 1995
- Medicare certification status
- Active
- Certified beds
- 60
- Chain
- Sovereign Healthcare Holdings
- Penalties (3 years)
- 2
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D0697069 | Pinellas Point Nursing and Rehab Center | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryNetworks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
Ownership & related parties
All disclosed owners & managing parties 18
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 |
|---|---|---|---|
| Susan Kaar | Managing Control - Governing Body | May 19, 2009 | |
| Adp of the SNF | May 19, 2009 | ||
| Sovereign Healthcare Disbursements LLC | Adp of the SNF | May 19, 2009 | |
| Fadi E Saba | Operational/Managerial Control | Jan 23, 2018 | |
| Adp of the SNF | Jan 23, 2018 | ||
| Centennial Bank | 5% Or Greater Security Interest | Sep 15, 2014 | 100% |
| Frederick Landy | Managing Control - Governing Body | Dec 13, 2022 | |
| Adp of the SNF | Dec 13, 2022 | ||
| John Mangine | Operational/Managerial Control | Jun 25, 2012 | |
| Adp of the SNF | Jun 25, 2012 | ||
| Indirect Ownership Interest | Jun 25, 2012 | 3% | |
| Southern Healthcare Management LLC | Operational/Managerial Control | Oct 1, 2003 | |
| Andrea N McCullough | Operational/Managerial Control | Jul 8, 2024 | |
| Adp of the SNF | Jul 8, 2024 | ||
| Donald K Melton | Operational/Managerial Control | Feb 15, 2009 | |
| Adp of the SNF | Feb 15, 2009 | ||
| William Notermann | Operational/Managerial Control | Jan 1, 2025 | |
| Adp of the SNF | Jan 1, 2025 | ||
| Sovereign Healthcare Holdings LLC | 5% Or Greater Direct Ownership Interest | Oct 1, 2003 | 100% |
| Royce M Cronquist | Operational/Managerial Control | Feb 1, 2018 | |
| Adp of the SNF | Oct 11, 2017 | ||
| John J Notermann Business TR | 5% Or Greater Indirect Ownership Interest | Nov 12, 2017 | 82.5% |
| Forvis Mazars LLP | Adp of the SNF | Jan 1, 2025 | |
| Dawn Chery | Managing Control - Governing Body | Jun 8, 2017 | |
| Adp of the SNF | Jun 8, 2017 | ||
| Health Services Properties LLC | 5% Or Greater Security Interest | May 19, 2009 | 100% |
| Adp of the SNF | May 19, 2009 | ||
| FL Pinellas Point Holdings, LLC | 5% Or Greater Security Interest | May 19, 2009 | 100% |
| Adp of the SNF | May 19, 2009 | ||
| Cronquist 2015 Family TR | 5% Or Greater Indirect Ownership Interest | Dec 31, 2015 | 14.5% |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- St Petersburg, FL
- NPI 1588658348
Adp of the SNF, Operational/Managerial Control
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- NPI 1396021077
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-
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- NPI 1306199849
Southern Healthcare Management LLC
-
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- NPI 1457846453
Southern Healthcare Management LLC
-
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- Crestview, FL
- NPI 1821374505
Southern Healthcare Management LLC
-
- Skilled Nursing Facility
- Fort Walton Beach, FL
- NPI 1962788646
Southern Healthcare Management LLC
-
- Skilled Nursing Facility
- Lake Worth, FL
- NPI 1063263861
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-
- Skilled Nursing Facility
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- NPI 1932685880
Southern Healthcare Management LLC
-
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- NPI 1710795877
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-
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- NPI 1801152137
Southern Healthcare Management LLC
-
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- Winter Park, FL
- NPI 1881189884
Southern Healthcare Management LLC
-
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- NPI 1649523184
Southern Healthcare Management LLC
-
- Skilled Nursing Facility
- Melbourne, FL
- NPI 1831186477
Southern Healthcare Management LLC
Practitioners & affiliated clinicians
Affiliated clinicians 1
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": "1127952000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1411516800000",
"number": "1295722817",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5887 GLENRIDGE DR",
"address_2": "SUITE 150",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303285574",
"telephone_number": "404-574-2100",
"fax_number": "404-574-2105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5601 31ST ST S",
"city": "ST PETERSBURG",
"state": "FL",
"postal_code": "337124605",
"telephone_number": "727-867-6955",
"fax_number": "727-867-1824"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOVEREIGN HEALTHCARE OF PINELLAS POINT, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2005-09-29",
"last_updated": "2014-09-24",
"status": "A",
"authorized_official_last_name": "CRONQUIST",
"authorized_official_first_name": "R.",
"authorized_official_middle_name": "MARK",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "404-574-2100",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "FL",
"license": "SNF16060961",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VA",
"identifier": "V516P-6821",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "026348600",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Pinellas Point Nursing & Rehab Center",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in St Petersburg, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2014; 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.