Active NPI
Macon Operating LLC
- Skilled Nursing Facility
- Macon, GA
National Provider Identifier
1447775655
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- MACON OPERATING LLC
- Practice address
- 3051 Whiteside Rd
Macon, GA 31216-6209 - Phone
- (478) 788-1421
- NPI assigned
- Aug 8, 2017
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mendel Brecher
- Title
- Manager
- Phone
- (718) 484-8888
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
3051 Whiteside Rd
Macon, GA 31216-6209
Mailing address
5308 13TH Ave Ste 273
Brooklyn, NY 11219-3804
Phone (718) 484-8888
Other names 1
- Fountain Blue Rehab and Nursing
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170830000697 | GA | Part A Provider - Skilled Nursing Facility | 8325311137 | Practice locations: Macon, GA |
Skilled nursing facility certification: CCN 115636
- Legal name
- MACON OPERATING LLC
- Doing business as
- FOUNTAIN BLUE REHAB AND NURSING
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Mar 1, 1997
- Last certification
- Oct 3, 2024
- Beds
- 143
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- CONCORD REHAB
- Organization structure
- LLC
- Enrollment address
- 3051 Whiteside Rd
Macon, GA 31216-6209 - Nursing home name
- BLOSSOM HEALTHCARE & REHABILITATION CENTER
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Blossom Healthcare & Rehabilitation Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Mar 1, 1997
- Medicare certification status
- Active
- Certified beds
- 143
National Provider Directory
National Provider DirectoryOwnership & 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.
| Name | Role | Since | Share |
|---|---|---|---|
| Mendel Brecher | 5% Or Greater Indirect Ownership Interest | Aug 1, 2017 | 26% |
| Corporate Officer | Aug 1, 2017 | ||
| Chana Lichtman | 5% Or Greater Indirect Ownership Interest | Aug 1, 2017 | 14% |
| Macon Holdings Group LLC | 5% Or Greater Direct Ownership Interest | Aug 1, 2017 | 100% |
| Sara Lichtman | 5% Or Greater Indirect Ownership Interest | Aug 1, 2017 | 12% |
| Renee Jiles | W-2 Managing Employee | Aug 1, 2017 | |
| Anshel Niederman | 5% Or Greater Indirect Ownership Interest | Aug 1, 2017 | 10% |
| Jacob Zimmerman | 5% Or Greater Indirect Ownership Interest | Aug 1, 2017 | 12% |
| Libby Brecher | 5% Or Greater Indirect Ownership Interest | Aug 1, 2017 | |
| Servisfirst Bank | 5% Or Greater Security Interest | Aug 1, 2017 | 100% |
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Macon, GA
- NPI 1912947326
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": "1502150400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1504051200000",
"number": "1447775655",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5308 13TH AVE STE 273",
"city": "BROOKLYN",
"state": "NY",
"postal_code": "112193804",
"telephone_number": "718-484-8888"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3051 WHITESIDE RD",
"city": "MACON",
"state": "GA",
"postal_code": "312166209",
"telephone_number": "478-788-1421"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MACON OPERATING LLC",
"organizational_subpart": "NO",
"enumeration_date": "2017-08-08",
"last_updated": "2017-08-30",
"status": "A",
"authorized_official_last_name": "BRECHER",
"authorized_official_first_name": "MENDEL",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "718-484-8888"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Fountain Blue Rehab and Nursing",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Macon, GA
- Macon Medical Clinic, LLC.
- Macon Medical Group PC
- Macon Northside Hospital, LLC
- Macon Occupational Medicine
- Macon Occupational Medicine
- Macon Oral and Maxillofacial Surgery,P.C.
- Macon Orthopaedic & Hand Center PA
- Macon Orthopaedic & Hand Center PA
- Macon Orthopaedic & Hand Center, PA
- Macon Orthopaedic & Hand Center, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2017; 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.