Prairie View Skilled Nursing LLC
Organization Active NPI Skilled Nursing Facility · Bloomfield, MO
NPI 1477008779 · NPPES record last updated Apr 8, 2024
Key facts
- NPI
- 1477008779
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- PRAIRIE VIEW SKILLED NURSING LLC
- Practice address
- 606 W Missouri St
Bloomfield, MO 63825-9706 - Phone
- (573) 568-2137
- Fax
- (573) 568-9906
- NPI assigned
- Aug 17, 2016
- Organization subpart
- No
Authorized official
- Name
- Mr. Benjamin P Sells
- Title
- Ceo
- Phone
- (573) 703-3049
Facilities with the same owner 87
Practitioners 2
-
Christopher R Montgomery, M.D.
-
Angela L Patterson, M.D.
Affiliated clinicians 1
-
Angela L Patterson, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Prairie View Skilled Nursing
- Overall star rating
- ★★☆☆☆ 2 of 5
- Health inspections
- ★★★★☆ 4 of 5
- Staffing
- ★☆☆☆☆ 1 of 5
- Quality measures
- ★☆☆☆☆ 1 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jun 1, 1991
- Medicare certification status
- Active
- Certified beds
- 60 · 44.7 residents per day on average
- Chain
- Paradigm Senior Management
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 26D2298160 | Prairie View Skilled Nursing | Certificate of waiver | Jan 29, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Skilled nursing facility certification: CCN 265451
- Legal name
- PRAIRIE VIEW SKILLED NURSING, LLC
- Doing business as
- PRAIRIE VIEW SKILLED NURSING
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jun 1, 1991
- Last certification
- Apr 3, 2025
- Beds
- 60
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Paradigm Senior Management
- Most recent change of ownership
- Jan 23, 2024
- Organization structure
- LLC · Proprietary
- Enrollment address
- 606 W Missouri St
Bloomfield, MO 63825-9706 - Nursing home name
- PRAIRIE VIEW SKILLED NURSING
- Affiliated entity
- PARADIGM SENIOR MANAGEMENT
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Benjamin P Sells |
5% Or Greater Direct Ownership Interest |
Jan 23, 2024 | 50% |
| Corporate Officer |
Jan 23, 2024 | 50% | |
| Operational/Managerial Control | Jan 24, 2023 | ||
| Maci Harris |
Operational/Managerial Control | Jan 22, 2025 | |
| Adp of the SNF | Jan 22, 2025 | ||
| Brittany Johnson |
Operational/Managerial Control | Jan 22, 2025 | |
| Adp of the SNF | Jan 22, 2025 | ||
| Angela R Jones |
5% Or Greater Direct Ownership Interest |
Jan 23, 2024 | 50% |
| Corporate Officer |
Jan 23, 2024 | 50% | |
| Alliance Bank |
5% Or Greater Mortgage Interest | Apr 24, 2023 | 100% |
| Adp of the SNF | Mar 24, 2025 | ||
| |
Adp of the SNF | Jan 23, 2024 | |
| |
Adp of the SNF | Mar 24, 2025 | |
| Paradigm Senior Management LLC |
Operational/Managerial Control | Jan 23, 2024 | 100% |
| Adp of the SNF | Mar 24, 2025 | ||
| |
Adp of the SNF | Apr 24, 2023 | |
| Dalen Hutchinson |
Operational/Managerial Control | Jan 23, 2024 | |
| Adp of the SNF | Jan 23, 2024 | ||
| Forvis Mazars LLP |
Operational/Managerial Control | Jan 1, 2025 | |
| Adp of the SNF | Mar 24, 2025 | ||
| |
Adp of the SNF | Jan 23, 2024 | |
| Paradigm Rehab Services LLC |
Operational/Managerial Control | Sep 1, 2024 | |
| Adp of the SNF | Mar 24, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240222000493 | MO | Part a Provider - Skilled Nursing Facility | 3577907112 | Practice locations: Bloomfield, MO |
National Provider Directory
Locations
606 W Missouri St
Bloomfield, MO 63825
Phone (573) 568-2137
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
606 W Missouri St
Bloomfield, MO 63825-9706
Mailing address
606 W Missouri St
Bloomfield, MO 63825-9706
Phone (573) 568-2137
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101456002 | Medicaid | MO |
Other names
- Prairie View Skilled Nursing
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All providers in Bloomfield, MO · Skilled Nursing Facility in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.