Flo-GP Leasing Co., LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

030945 Issued in MO

Legal business name

FLO-GP LEASING CO., LLC

Doing business as

Crystal Creek Health and Rehabilitation Center

Practice address

250 S New Florissant Rd
Florissant, MO 63031-6716

Phone

(314) 838-2211

Fax

(314) 838-5981

NPI assigned

Nov 14, 2005

Last updated

Sep 28, 2022By 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

Charles Stoltz

Title

Cfo

Phone

(513) 489-7100

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Crystal Creek Health and Rehabilitation Center Doing business as

Electronic endpoints 1

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

CLIA laboratory certificates

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.

• Iqbal Amin, M.D.

  • Geriatric Medicine (Internal Medicine) Physician
  • Saint Louis, MO
  • NPI 1184619835
  NPD (past)

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

{
    "created_epoch": "1131926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664323200000",
    "number": "1437130747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 ASHWOOD DR",
            "address_2": "SUITE 200",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452412465",
            "telephone_number": "513-489-7100",
            "fax_number": "513-530-1359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 S NEW FLORISSANT RD",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630316716",
            "telephone_number": "314-838-2211",
            "fax_number": "314-838-5981"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLO-GP LEASING CO., LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-14",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A",
        "authorized_official_last_name": "STOLTZ",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "513-489-7100"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "030945",
            "primary": true
        },
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107807703",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1066.1",
            "affiliationName": "eSolutions Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Crystal Creek Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Crystal Creek Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nicole Fix-Miller, BCBA, LBA
• Kelsey N Fix
• Danita Flakes, MSW, LCSW, ICADC
• Jonette Fleming
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• Florissant Chiropractic Center Inc
• Florissant Dental Care-Ronald K Greif, DDS-Samir Ruvinov, DDS, LLC (Florissant Dental Care)
• Florissant Healthcare, LLC

• Skilled Nursing Facility in Florissant, MO
• Providers in Florissant, MO by specialty
• Skilled Nursing Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.