NPIMap

Organization Active NPI

Avamere Lake Oswego Operations Investors, LLC

  • Skilled Nursing Facility
  • Lake Oswego, OR
National Provider Identifier
1437176344
Registry record updated Feb 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
AVAMERE LAKE OSWEGO OPERATIONS INVESTORS, LLC
Practice address
4550 Carman Dr
Lake Oswego, OR 97035-2520
Phone
(503) 675-6055
NPI assigned
Jul 16, 2006
Last updated
Feb 17, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2025

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

Authorized official

Name
Mary E. Kofstad
Title
Ceo
Phone
(971) 224-2033

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

4550 Carman Dr
Lake Oswego, OR 97035-2520

Mailing address

4550 Carman Dr
Lake Oswego, OR 97035-2520
Phone (503) 675-6055

Electronic endpoints 1

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050617000204 OR Part A Provider - Skilled Nursing Facility 0941244255 Practice locations: Lake Oswego, OR

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437176344. Details of each certification follow.

Skilled nursing facility certification: CCN 385271

Legal name
AVAMERE LAKE OSWEGO OPERATIONS INVESTORS, LLC
Doing business as
THE PEARL AT KRUSE WAY
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 25, 2006
Last certification
Aug 2, 2024
Beds
74
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Avamere
Organization structure
LLCProprietary
Incorporated
Sep 29, 2004 in OR
Enrollment address
4550 Carman Dr
Lake Oswego, OR 97035-2520
Nursing home name
PEARL AT KRUSE WAY, THE
Affiliated entity
AVAMERE

Care Compare: Nursing home

Medicare Care Compare
Listed as
The PEARL AT KRUSE WAYCCN 385271 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jan 25, 2006
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7440.6 residents per day on average
Chain
Avamere27 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Locations

4550 Carman Dr
Lake Oswego, OR 97035
Phone (503) 367-3134

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Avamere Skilled Advisors LLC Organization, Wilsonville, OR LLC, Consulting firm Other Jan 1, 2022
Karl Rickard Miller Individual 5% Or Greater Indirect Ownership InterestN/a May 31, 2005 100%
Ari Operations, LLC Organization, Wilsonville, OR LLC, For-profit 5% Or Greater Indirect Ownership Interest Aug 24, 2011 100%
Kirsten Carr Individual Contracted Managing EmployeeMD; Apr 1, 2022
Andrew Simpson Individual Corporate OfficerCfo Jun 1, 2024
Erik D Margolis Individual W-2 Managing EmployeeAd; Apr 10, 2024
Avamere Health Services LLC Organization, Wilsonville, OR Chain home office Other Jan 1, 2007 100%
Avamere Group LLC Organization, Wilsonville, OR LLC, For-profit 5% Or Greater Indirect Ownership Interest Aug 24, 2011 100%
Mary Kofstad Individual Corporate OfficerCoo Feb 13, 2024
Ari CBC LLC Organization, Wilsonville, OR LLC, Holding company 5% Or Greater Direct Ownership Interest Aug 24, 2011 100%

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 11

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": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739750400000",
    "number": "1437176344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4550 CARMAN DR",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352520",
            "telephone_number": "503-675-6055",
            "fax_number": "503-675-6077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4550 CARMAN DR",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970352520",
            "telephone_number": "503-675-6055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVAMERE LAKE OSWEGO OPERATIONS INVESTORS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2025-02-17",
        "certification_date": "2025-02-17",
        "status": "A",
        "authorized_official_last_name": "KOFSTAD",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "971-224-2033"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinServi",
            "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": "64 S Price Rd Ste B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lake Oswego, OR

Sources for this page

Verify at the official NPI Registry.