Village Shalom, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

N046054 Issued in KS

Legal business name

VILLAGE SHALOM, INC

Practice address

5500 W 123Rd St
Overland Park, KS 66209-3193

Phone

(913) 317-2600

NPI assigned

Mar 31, 2006

Last updated

Jan 28, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Matthew Earl Lewis

Title

President/Ceo

Phone

(913) 266-8400

Specialties & licenses 4

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1316908163. Details of each certification follow.

• CCN 175441 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 175441

Legal name

VILLAGE SHALOM, INC

Doing business as

NEXDINE HOSPITALITY

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Oct 31, 2000

Last certification

Oct 19, 2023

Beds

219 (66 certified)

Ownership / control type

Other Nonprofit

Organization structure

CorporationNon-profit

Enrollment address

5500 W 123Rd St
Overland Park, KS 66209-3193

Nursing home name

VILLAGE SHALOM INC

Listed as

Village Shalom IncCCN 175441 · All quality measures

Overall star rating

4 of 5

Health inspections

2 of 5

Staffing

5 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Other

Certified

Oct 31, 2000

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

6655.0 residents per day on average

Penalties (3 years)

2Fines totaling $16,153

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 19

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

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Bradley H Koffman, MD

  • Radiation Oncology Physician
  • Overland Park, KS
  • NPI 1659334282

  Corporate Director

  CMS ownership
• Jessica Nicole Lee, DO

  • Internal Medicine Physician
  • Lee's Summit, MO
  • NPI 1811284607

  Adp of the SNF

  CMS ownership

Practitioners 1

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.

• Jessica Nicole Lee, DO

  • Internal Medicine Physician
  • Lee's Summit, MO
  • NPI 1811284607
  NPD (past)

Affiliated clinicians 8

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Martha Ann Allen, M.D.

  • Internal Medicine Physician
  • Overland Park, KS
  • NPI 1457618993

  Nursing home

  Care Compare affiliation
• Jennifer L Brown, MD

  • Internal Medicine Physician
  • Overland Park, KS
  • NPI 1285625277

  Nursing home

  Care Compare affiliation
• Donald L Cohen, DO

  • Internal Medicine Physician
  • Overland Park, KS
  • NPI 1093703373

  Nursing home

  Care Compare affiliation
• Paul Piezas Pena, MD

  • Internal Medicine Physician
  • Overland Park, KS
  • NPI 1497017149

  Nursing home

  Care Compare affiliation
• Nidal Boutros

  • Internal Medicine Physician
  • Lebanon, MO
  • NPI 1629036173

  Nursing home

  Care Compare affiliation
• Sarah Elizabeth Hugo, M.D.

  • Internal Medicine Physician
  • Rochester, MN
  • NPI 1154587517

  Nursing home

  Care Compare affiliation
• Jessica Nicole Lee, DO

  • Internal Medicine Physician
  • Lee's Summit, MO
  • NPI 1811284607

  Nursing home

  Care Compare affiliation
• Garrett Wilt, DO

  • Internal Medicine Physician
  • Des Moines, IA
  • NPI 1518535913

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264636800000",
    "number": "1316908163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 W 123RD ST",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662093193",
            "telephone_number": "913-317-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5500 W 123RD ST",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662093193",
            "telephone_number": "913-317-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE SHALOM, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-31",
        "last_updated": "2010-01-28",
        "status": "A",
        "authorized_official_last_name": "LEWIS",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "EARL",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "913-266-8400",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "KS",
            "license": "N046054",
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "KS",
            "license": "N046054",
            "primary": false
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "KS",
            "license": "N046054",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "KS",
            "license": "N046054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100112060A",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "90924016",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in Overland Park, KS
• Providers in Overland Park, KS by specialty
• Skilled Nursing Facility in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2010; 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.

Verify at the official NPI Registry.