NPIMap

Organization Active NPI

Vibra Hospital of San Bernardino, LLC

Doing business as Ballard Rehabilitation Hospital

  • Rehabilitation Hospital
  • San Bernardino, CA
National Provider Identifier
1497748081
Registry record updated Oct 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation HospitalTaxonomy code 283X00000X
License
240000502 Issued in CA
Legal business name
VIBRA HOSPITAL OF SAN BERNARDINO, LLC
Doing business as
Ballard Rehabilitation Hospital
Practice address
1760 W 16TH St
San Bernardino, CA 92411-1160
Phone
(909) 473-1200
Fax
(909) 473-1276
NPI assigned
Aug 29, 2005
Last updated
Oct 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2023

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

Authorized official

Name
Mr. Brad Eugene Hollinger
Title
President
Phone
(717) 591-5700

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital 283X00000X 240000502 CA Primary

Addresses

Primary practice location

1760 W 16TH St
San Bernardino, CA 92411-1160

Mailing address

PO Box 26657
Fresno, CA 93729-6657
Phone (559) 892-2500

Other identifiers 3

IdentifierTypeStateIssuer
1497748081MedicaidCA
120321000OtherDEPT OF LABOR
ZZZH3608ZOtherBLUE SHIELD

Other names 1

  • Ballard Rehabilitation Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080410000860 CA Part A Provider - Hospital 7517044829 Practice locations: San Bernardino, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1497748081. Details of each certification follow.

Hospital certification: CCN 053037

Legal name
VIBRA HOSPITAL OF SAN BERNARDINO, LLC
Doing business as
BALLARD REHABILITATION HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Rehabilitation
Participating since
Jul 27, 1993
Last certification
Nov 5, 2021
Beds
60
Ownership / control type
Private (not for profit)
Most recent change of ownership
Jul 1, 2008 (3 total)
Organization structure
LLCProprietary
Incorporated
Nov 21, 2007 in DE
Enrollment address
1760 W 16TH St
San Bernardino, CA 92411-1160
Other Hospital Practice Location
Hospital subgroups
Rehabilitation

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Ballard Rehabilitation HospitalCCN 053037 · All quality measures
Ownership
Non-profit
Certified
Jul 27, 1993
Medicare certification status
ActiveFrom the Provider of Services file

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
05D0873272Vibra Hospital of San Bernardino, LLC1760 W 16TH St, San Bernardino, CA 92411ComplianceFeb 28, 2026

National Provider Directory

National Provider Directory

Locations

19153 Town Center Dr
Ste 104
Apple Valley, CA 92308
Phone (760) 247-4480

16855 Valley Blvd
Ste A
Fontana, CA 92335
Phone (909) 355-4888

12625 Frederick St
Ste E6
Moreno Valley, CA 92553
Phone (951) 653-8200

3800 La Sierra Ave
#A
Riverside, CA 92505
Phone (951) 688-3888

18560 Van Buren Blvd
Ste 1A
Riverside, CA 92508
Phone (951) 780-1500

Networks

  • BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Craig Johnson Individual W-2 Managing EmployeeInterim Chief Executive Office Sep 29, 2023
James a Diebold Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2009 8.6%
Kelly M Hollinger Individual Corporate OfficerVice President Mar 1, 2020
Vibra Management, LLC Organization, Mechanicsburg, PA LLC, For-profit Other Jul 1, 2008
Credit Suisse Ag Organization, New York, NY Corporation, Investment firm 5% Or Greater Security Interest Jul 22, 2020 92%
David E Hauck Individual Corporate OfficerTreasurer Oct 4, 2018
Hollinger Holding Company LLC Organization, Mechanicsburg, PA LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2009 86%
The Carr Living Trust Organization, Burlingame, CA 5% Or Greater Indirect Ownership Interest Jan 1, 2009 6.02%
MPT of San Bernadino - Vibra, L.P. Organization, Mechanicsburg, PA Created for acquisition, Investment firm, For-profit 5% Or Greater Security Interest Aug 30, 2019 8%
Other Aug 30, 2019 8%
Francis D Carr Individual 5% Or Greater Indirect Ownership Interest Jan 1, 2009 6.02%
Trisha J Niemuth Individual Corporate OfficerVP/Sec Jan 1, 2022
Vibra Healthcare, LLC Organization, Mechanicsburg, PA LLC, For-profit 5% Or Greater Direct Ownership Interest Jul 1, 2008 100%
Brad E Hollinger Individual 5% Or Greater Indirect Ownership Interest Jul 1, 2008 71.38%
Corporate OfficerPresident Jun 24, 2005

Facilities with the same owner 7

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

Practitioners & affiliated clinicians

Affiliated clinicians 11

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": "1125273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696896000000",
    "number": "1497748081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26657",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937296657",
            "telephone_number": "559-892-2500",
            "fax_number": "559-892-2444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1760 W 16TH ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924111160",
            "telephone_number": "909-473-1200",
            "fax_number": "909-473-1276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIBRA HOSPITAL OF SAN BERNARDINO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-29",
        "last_updated": "2023-10-10",
        "status": "A",
        "authorized_official_last_name": "HOLLINGER",
        "authorized_official_first_name": "BRAD",
        "authorized_official_middle_name": "EUGENE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "717-591-5700",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "283X00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Hospital",
            "state": "CA",
            "license": "240000502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1497748081",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEPT OF LABOR",
            "identifier": "120321000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZH3608Z",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ballard Rehabilitation Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ballard Rehabilitation Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in San Bernardino, CA

Sources for this page

Verify at the official NPI Registry.