NPIMap

Organization Active NPI

Northport Health Services of Florida, LLC

Doing business as Crystal River Health & Rehabilitation Center

  • Skilled Nursing Facility
  • Crystal River, FL
National Provider Identifier
1396790622
Registry record updated Oct 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
SNF1114096 Issued in FL
Legal business name
NORTHPORT HEALTH SERVICES OF FLORIDA, LLC
Doing business as
Crystal River Health & Rehabilitation Center
Practice address
136 NE 12TH Ave
Crystal River, FL 34429-4553
Phone
(352) 795-5044
NPI assigned
May 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2020

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

Authorized official

Name
Phillip Cody Long
Title
Cfo
Phone
(204) 391-3600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X SNF1114096 FL Primary

Addresses

Primary practice location

136 NE 12TH Ave
Crystal River, FL 34429-4553

Mailing address

136 NE 12TH Ave
Crystal River, FL 34429-4553

Other identifiers 1

IdentifierTypeStateIssuer
021726300MedicaidFL

Other names 1

  • Crystal River Health & Rehabilitation Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070718000224 FL Part A Provider - Skilled Nursing Facility 4789692500 Practice locations: Crystal River, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396790622. Details of each certification follow.

Skilled nursing facility certification: CCN 105317

Legal name
NORTHPORT HEALTH SERVICES OF FLORIDA, LLC
Doing business as
CRYSTAL RIVER HEALTH AND REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Aug 26, 1977
Last certification
Oct 24, 2024
Beds
150
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Northport Health Services of Florida, LLC.
Organization structure
LLCProprietary
Incorporated
Feb 19, 1999 in FL
Enrollment address
136 Ne12Th Ave
Crystal River, FL 34429-4553
Nursing home name
CRYSTAL RIVER HEALTH AND REHABILITATION CENTER
Affiliated entity
NHS MANAGEMENT

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Crystal River Health and Rehabilitation CenterCCN 105317 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Aug 26, 1977
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
150133.0 residents per day on average
Chain
NHS Management43 facilities in the chain

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
10D0860809Crystal River Health and Rehabilitation Center136 NE 12TH Ave, Crystal River, FL 34429Certificate of waiverApr 17, 2028

National Provider Directory

National Provider Directory

Locations

136 NE 12th Ave
Crystal River, FL 34429
Phone (352) 795-5044

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
James Norman Estes Jr TR Organization, Vestavia, AL 5% Or Greater Direct Ownership Interest Jun 30, 2013 6.25%
Lynn S Rasco Individual Corporate DirectorDirector of Qa/Corp Compliance Ofcr Jul 1, 2022 25%
Operational/Managerial ControlDirector of Qa/Corp Compliance Ofcr Jul 1, 2022 25%
Jennifer Lee Estes TR 031093 Organization, Vestavia, AL 5% Or Greater Direct Ownership Interest Jun 30, 2013 6.25%
Cheri L McVea Individual Corporate DirectorRegional Nurse Consultant Sep 27, 2021 25%
Operational/Managerial ControlRegional Nurse Consultant Sep 27, 2021 25%
James Norman Estes Individual 5% Or Greater Direct Ownership InterestPresident/Treasurer Feb 19, 1999 67.5%
Corporate OfficerPresident/Treasurer Feb 19, 1999 100%
Phillip Cody Long Individual Corporate OfficerVice President/Secretary Oct 1, 2019
Other Jan 1, 2022 32.5%
Jennifer E Agee Family Dynasty TR No 2 Organization, Tuscaloosa, AL 5% Or Greater Direct Ownership Interest Sep 30, 2019 10%
James N Estes Jr Family Dynasty TR No 2 Organization, Tuscaloosa, AL 5% Or Greater Direct Ownership Interest Sep 30, 2019 10%
Regions Bank Organization, Birmingham, AL Financial institution, For-profit 5% Or Greater Security Interest Aug 26, 2014
Brandon S. Agee Individual Other Jan 1, 2022 32.5%
Darin Toney Individual Corporate DirectorRegional Administrator Apr 15, 2024 25%
Operational/Managerial ControlRegional Administrator Apr 15, 2024 25%
NHS Management LLC Organization, Tuscaloosa, AL LLC, For-profit Other Jun 1, 2007
Robert V Boyd Individual W-2 Managing EmployeeAd; Mar 23, 2024 100%
Operational/Managerial ControlAdministrator Mar 23, 2024 100%
Julie W. Schneider Individual Corporate DirectorRegional Nurse Consultant Apr 21, 2023 25%
Operational/Managerial ControlRegional Nurse Consultant Apr 21, 2023 25%

Facilities with the same owner 42

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

View all 42

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1603756800000",
    "number": "1396790622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "136 NE 12TH AVE",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344294553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 NE 12TH AVE",
            "city": "CRYSTAL RIVER",
            "state": "FL",
            "postal_code": "344294553",
            "telephone_number": "352-795-5044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHPORT HEALTH SERVICES OF FLORIDA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-24",
        "last_updated": "2020-10-27",
        "certification_date": "2020-10-27",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "CODY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "204-391-3600"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF1114096",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "021726300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crystal River Health & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Crystal River Health & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crystal River, FL

Sources for this page

Verify at the official NPI Registry.