NPIMap

Organization Active NPI

Ignite Medical Resort Okc, LLC

  • Skilled Nursing Facility
  • Oklahoma City, OK
National Provider Identifier
1316577679
Registry record updated Sep 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
IGNITE MEDICAL RESORT OKC, LLC
Practice address
6312 N Portland Ave
Oklahoma City, OK 73112-1463
Phone
(405) 946-6932
NPI assigned
Jan 24, 2020
Last updated
Sep 4, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2020

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

Authorized official

Name
Jaret Glazer
Title
Attorney
Phone
(847) 324-7993

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

6312 N Portland Ave
Oklahoma City, OK 73112-1463

Mailing address

1550 N Northwest Hwy Ste 430
Park Ridge, IL 60068-1411

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200608001593 OK Part A Provider - Skilled Nursing Facility 3971924564 1 other NPI on this enrollment
Practice locations: Oklahoma City, OK

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316577679. Details of each certification follow.

Skilled nursing facility certification: CCN 375412

Legal name
IGNITE MEDICAL RESORT OKC, LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 24, 2002
Last certification
Mar 29, 2024
Beds
75
Ownership / control type
Corporation
Multi-facility organization
Sabra
Organization structure
LLCProprietary
Incorporated
Dec 11, 2019 in OK
Enrollment address
6312 N Portland Ave
Oklahoma City, OK 73112-1463
Nursing home name
IGNITE MEDICAL RESORT OKC, LLC
Affiliated entity
IGNITE MEDICAL RESORTS

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Nursing home

Medicare Care Compare
Listed as
Ignite Medical Resort Okc, LLCCCN 375412 · All quality measures
Overall star rating
2 of 5
Health inspections
3 of 5
Staffing
1 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
May 24, 2002
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7572.7 residents per day on average
Chain
Ignite Medical Resorts22 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Ignite Medical Resort Okc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 34

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

NameRoleSinceShare
Israel Family Investment Trust Organization, Lincolnwood, IL Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 1, 2020 8.34%
Ignite Oklahoma JV, LLC Organization, Park Ridge, IL Created for acquisition, LLC, Holding company, Owned by another organization or individual Direct Ownership Interest Mar 1, 2020 50%
John T McFarlane Individual Operational/Managerial Control Mar 1, 2021
Adp of the SNF Mar 1, 2020
Indirect Ownership Interest Mar 1, 2020 1%
Sabra Health Care Reit Inc Organization, Tustin, CA Corporation Adp of the SNF Jan 1, 2020
Jim White Individual Operational/Managerial Control Mar 1, 2020
Adp of the SNF Mar 1, 2020
Indirect Ownership Interest Mar 1, 2020 1%
Whitney Henry Individual Operational/Managerial Control Dec 16, 2024
Adp of the SNF Dec 16, 2024
Todd a Stern Individual Operational/Managerial Control Mar 1, 2020
Managing Control - Governing BodyInvestor Mar 1, 2020
Barry Carr Individual 5% Or Greater Indirect Ownership Interest Dec 11, 2019 35.99%
Operational/Managerial Control Mar 1, 2020
Managing Control - Governing BodyManager Mar 1, 2020
Adp of the SNF Mar 1, 2020
Luxe Staffing LLC Organization, Park Ridge, IL LLC, Medical staffing company, For-profit Adp of the SNF Jan 4, 2021
Rachel Shearer Individual Operational/Managerial Control Mar 1, 2020
Adp of the SNF Mar 1, 2020
Indirect Ownership Interest Mar 1, 2020 1%
Jared Carr Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 1, 2025
Indirect Ownership Interest Jan 1, 2025 3%
Marc L Rose Individual Operational/Managerial Control Mar 20, 2020
Adp of the SNF Mar 20, 2020
Indirect Ownership Interest Mar 20, 2020 1%
Benjamin Israel Individual Managing Control - Governing BodyManager Mar 1, 2020
Gold Pearl, LLC Organization, Park Ridge, IL LLC, Holding company, Owned by another organization or individual Indirect Ownership Interest Jan 3, 2022 4%
Organization, Johnsburg, IL LLC, Holding company, For-profit, Owned by another organization or individual Indirect Ownership Interest Mar 1, 2020 1%
Spark Therapy LLC Organization, Park Ridge, IL LLC, Medical staffing company Operational/Managerial Control Mar 1, 2020
Adp of the SNF Jun 26, 2025
Prestige Worldwide Oklahoma, LLC Organization, Park Ridge, IL LLC, For-profit, Owned by another organization or individual Indirect Ownership Interest Mar 1, 2020 10%
Israel Investment TR Organization, Lincolnwood, IL Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 1, 2020 8.33%
Meaghan Skelton Individual Operational/Managerial Control Jan 1, 2022
Adp of the SNF Jan 1, 2022
Indirect Ownership Interest Jan 1, 2022 1%
Organization, Park Ridge, IL LLC Adp of the SNF Jul 16, 2025
Ryan Gobst Individual Indirect Ownership Interest Mar 1, 2020 2%
Ignite Team Partners LLC Organization, Park Ridge, IL LLC, Management services company, Consulting firm, For-profit Operational/Managerial Control Mar 1, 2020
Adp of the SNF Jun 26, 2025
Blue Pearl Financial LLC Organization, Park Ridge, IL LLC, Holding company, For-profit, Owned by another organization or individual Indirect Ownership Interest Mar 1, 2020 16%
Teney V John Individual Operational/Managerial Control Jan 1, 2022
Adp of the SNF Jan 1, 2022
Stern Family Investment TR Organization, Skokie, IL Owned by another organization or individual Indirect Ownership Interest Mar 1, 2020 16.66%
Menachem Berger Individual Managing Control - Governing BodyInvestor Mar 1, 2020
Ignite Post Acute Solutions LLC Organization, Park Ridge, IL LLC, Holding company, For-profit, Owned by another organization or individual Indirect Ownership Interest Mar 1, 2020 20%
Ignite-Villa Holdco LLC Organization, Park Ridge, IL LLC, Holding company, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Mar 1, 2020 50%
Chelsey Rolf Individual Indirect Ownership Interest Aug 1, 2024 1%
Timothy Fields Individual 5% Or Greater Indirect Ownership Interest Mar 1, 2020 20%
Operational/Managerial ControlChief Executive Officer Mar 1, 2020 100%
Managing Control - Governing BodyManager Mar 1, 2020
Adp of the SNF Mar 1, 2020
Mathew Thengil Individual Operational/Managerial Control Mar 1, 2020
Adp of the SNF Mar 1, 2020
Indirect Ownership Interest Mar 1, 2020 1%
Revel L Castillo-Simon Individual Indirect Ownership Interest Jan 1, 2023 1%
Berger Fam TR Ua 06252014 Organization, Chicago, IL Indirect Ownership Interest Mar 1, 2020 16.67%
Nicole Jablonski Individual Operational/Managerial Control Mar 1, 2020
Adp of the SNF Mar 1, 2020
Indirect Ownership Interest Mar 1, 2020 1%

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 32

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

View all 32

Practitioners & affiliated clinicians

Practitioners 6

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 5

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": "1579824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599177600000",
    "number": "1316577679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 N NORTHWEST HWY STE 430",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6312 N PORTLAND AVE",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731121463",
            "telephone_number": "405-946-6932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IGNITE MEDICAL RESORT OKC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-24",
        "last_updated": "2020-09-04",
        "certification_date": "2020-09-04",
        "status": "A",
        "authorized_official_last_name": "GLAZER",
        "authorized_official_first_name": "JARET",
        "authorized_official_title_or_position": "ATTORNEY",
        "authorized_official_telephone_number": "847-324-7993"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.