Active NPI
Oaks on the Bay, LLC
Doing business as The Oaks of Clearwater
- Skilled Nursing Facility
- Clearwater, FL
National Provider Identifier
1609297654
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- OAKS ON THE BAY, LLC
- Doing business as
- The Oaks of Clearwater
- Practice address
- 420 Bay Ave
Clearwater, FL 33756-5291 - Phone
- (727) 445-4700
- Fax
- (727) 462-9902
- NPI assigned
- Dec 18, 2013
- Last updated
- Aug 30, 2016
- 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
- Mr. David C Jones
- Title
- Officer/Owner
- Phone
- (727) 683-1200
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
420 Bay Ave
Clearwater, FL 33756-5291
Mailing address
420 Bay Ave
Clearwater, FL 33756-5291
Phone (727) 445-4700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 010139100 | Medicaid | FL |
Other names 1
- The Oaks of Clearwater
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140213000470 | FL | Part A Provider - Skilled Nursing Facility | 4789813874 | Practice locations: Clearwater, FL |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1609297654. Details of each certification follow.
Skilled nursing facility certification: CCN 105323
- Legal name
- OAKS ON THE BAY LLC
- Doing business as
- THE OAKS OF CLEARWATER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF distinct part
- Participating since
- Feb 14, 1978
- Last certification
- Sep 20, 2023
- Beds
- 60
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC
- Incorporated
- Oct 22, 2013 in FL
- Enrollment address
- 420 Bay Avenue
Clearwater, FL 33756-5291 - Nursing home name
- OAKS OF CLEARWATER, THE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Oaks of Clearwater, the
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Feb 14, 1978
- Medicare certification status
- Active
- Certified beds
- 60
National Provider Directory
National Provider Directory- Tax ID family
- Oaks on the Bay LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba The Oaks of Clearwater
- Assisted Living Facility
- Clearwater, FL
- NPI 1447261565
Networks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
Ownership & related parties
All disclosed owners & managing parties 6
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 |
|---|---|---|---|
| David Jones | 5% Or Greater Indirect Ownership Interest | Jan 17, 2014 | 5% |
| Oaks on the Bay LLC | 5% Or Greater Direct Ownership Interest | Jan 17, 2014 | 100% |
| Imad Lyzzaik | W-2 Managing Employee | Aug 12, 2018 | 100% |
| Frances Loretta Davis | Corporate Director | Jul 16, 2018 | |
| Spring Haven Retirement LLC | 5% Or Greater Direct Ownership Interest | Jan 17, 2014 | 100% |
| Terence J McCarthy | 5% Or Greater Indirect Ownership Interest | Jan 17, 2014 | 95% |
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": "1387324800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1472515200000",
"number": "1609297654",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 BAY AVE",
"city": "CLEARWATER",
"state": "FL",
"postal_code": "337565291",
"telephone_number": "727-445-4700",
"fax_number": "727-462-9902"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 BAY AVE",
"city": "CLEARWATER",
"state": "FL",
"postal_code": "337565291",
"telephone_number": "727-445-4700",
"fax_number": "727-462-9902"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "OAKS ON THE BAY, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2013-12-18",
"last_updated": "2016-08-30",
"status": "A",
"authorized_official_last_name": "JONES",
"authorized_official_first_name": "DAVID",
"authorized_official_middle_name": "C",
"authorized_official_title_or_position": "OFFICER/OWNER",
"authorized_official_telephone_number": "727-683-1200",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "010139100",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "The Oaks of Clearwater",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Clearwater, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2016; 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.