NPIMap

Organization Active NPI

Brooks Skilled Nursing Facility, a, Inc.

  • Skilled Nursing Facility
  • Jacksonville, FL
National Provider Identifier
1326362005
Registry record updated Dec 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
BROOKS SKILLED NURSING FACILITY, A, INC.
Practice address
6209 Brooks Bartram Dr BLDG 100
Jacksonville, FL 32258-5605
Phone
(904) 528-3010
Fax
(904) 528-3012
NPI assigned
Mar 24, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2025

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

Authorized official

Name
Jeni Allen
Title
Director of Managed Care
Phone
(904) 345-7158

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

6209 Brooks Bartram Dr BLDG 100
Jacksonville, FL 32258-5605

Mailing address

3599 University Blvd S
Jacksonville, FL 32216-4252
Phone (904) 345-7607

Other identifiers 1

IdentifierTypeStateIssuer
008699000MedicaidFL

Other names 1

  • Bartram Crossing Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100422000750 FL Part A Provider - Skilled Nursing Facility 8628105699 Practice locations: Jacksonville, FL

Skilled nursing facility certification: CCN 105645

Legal name
BROOKS SKILLED NURSING FACILITY, A, INC.
Doing business as
BARTRAM CROSSING
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 1, 1989
Last certification
May 23, 2024
Beds
100
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Enrollment address
6209 Brooks Bartram Dr Building 100
Jacksonville, FL 32258-5602
Nursing home name
BARTRAM CROSSING

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Bartram CrossingCCN 105645
Overall star rating
2 of 5
Health inspections
1 of 5
Staffing
5 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Jun 1, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
100109.3 residents per day on average
Abuse citation
Cited for abuse (Care Compare abuse icon)

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D0885026Bartram Crossing6209 Brooks Bartram Dr BLDG 100, Jacksonville, FL 32258Certificate of waiverApr 13, 2028

National Provider Directory

National Provider Directory
Tax ID family
Ability Network2 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 9

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

NameRoleSinceShare
Genesis Health Inc Organization, Jacksonville, FL Non-profit 5% Or Greater Indirect Ownership Interest Apr 28, 1982 100%
Brooks Skilled Nursing, Inc. Organization, Jacksonville, FL Corporation, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jun 1, 2010 100%
Chonglun Xie Individual Operational/Managerial Control Jan 1, 2020
Adp of the SNF Feb 24, 2025
Victor Derienzo Individual Corporate Officer Feb 1, 2023
Douglas Baer Individual Corporate DirectorCeo Jun 1, 2010
Eric Mann Individual Corporate DirectorDirector Feb 1, 2023
Jennifer Allen Individual Operational/Managerial Control Feb 10, 2025
James Tabor Individual Corporate OfficerChief Financial Officer Feb 28, 2022
Marc Lei Individual Operational/Managerial Control Feb 1, 2023
Adp of the SNF Feb 1, 2023

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 5

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

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": "1269388800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766448000000",
    "number": "1326362005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3599 UNIVERSITY BLVD S",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322164252",
            "telephone_number": "904-345-7607",
            "fax_number": "904-345-7284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6209 BROOKS BARTRAM DR BLDG 100",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322585605",
            "telephone_number": "904-528-3010",
            "fax_number": "904-528-3012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKS SKILLED NURSING FACILITY, A, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-24",
        "last_updated": "2025-12-23",
        "certification_date": "2025-12-23",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "JENI",
        "authorized_official_title_or_position": "DIRECTOR OF MANAGED CARE",
        "authorized_official_telephone_number": "904-345-7158"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008699000",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Bartram Crossing",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bartram Crossing",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, FL

Sources for this page

Verify at the official NPI Registry.