NPIMap

Organization Active NPI

Ensign Santa Rosa LLC

  • Skilled Nursing Facility
  • Santa Rosa, CA
National Provider Identifier
1619976552
Registry record updated Feb 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
010000078 Issued in CA
Legal business name
ENSIGN SANTA ROSA LLC
Practice address
1280 Summerfield Rd
Santa Rosa, CA 95405-7313
Phone
(707) 539-1515
Fax
(707) 539-0630
NPI assigned
Jul 20, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2021

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

Authorized official

Name
Ms. Soon Burnam
Title
Treasurer
Phone
(949) 540-1249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 010000078 CA Primary

Addresses

Primary practice location

1280 Summerfield Rd
Santa Rosa, CA 95405-7313

Mailing address

1280 Summerfield Rd
Santa Rosa, CA 95405-7313
Phone (707) 539-1515

Other identifiers 1

IdentifierTypeStateIssuer
ZZR06364JMedicaidCA

Other names 1

  • Summerfield Healthcare Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other eSolutions Inc.

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121231000365 CA Part A Provider - Skilled Nursing Facility 4284800293 Practice locations: Santa Rosa, CA

Skilled nursing facility certification: CCN 056364

Legal name
ENSIGN SANTA ROSA LLC
Doing business as
SUMMERFIELD HEATLHCARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 21, 1972
Last certification
Mar 15, 2024
Beds
70
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Ensign Facility Services
Organization structure
LLCProprietary
Incorporated
Jun 20, 2002 in NV
Enrollment address
1280 Summerfield Rd
Santa Rosa, CA 95405-7313
Nursing home name
SUMMERFIELD HEALTH CARE CENTER
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Summerfield Health Care CenterCCN 056364
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jun 21, 1972
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7052.9 residents per day on average
Chain
The Ensign Group342 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

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
05D0716912Summerfield Healthcare Center1280 Summerfield Rd, Santa Rosa, CA 95405Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & 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.

NameRoleSinceShare
Flagstone Healthcare North LLC Organization, San Juan Capistrano, CA LLC 5% Or Greater Direct Ownership Interest Feb 1, 2006 100%
Cason Bush Individual Operational/Managerial Control Jul 1, 2015
Managing Control - Governing BodyAdministrator Jul 1, 2015
Adp of the SNF Jul 1, 2015
The Ensign Group Inc Organization, San Juan Capistrano, CA Corporation, For-profit 5% Or Greater Indirect Ownership Interest Feb 1, 2006 100%
Ensign Services Inc Organization, San Juan Capistrano, CA Corporation Adp of the SNF Aug 1, 2002
Adam Willits Individual Corporate OfficerSole Manager Sep 1, 2017
Aynna Yee Sae Individual Operational/Managerial Control Jan 1, 2025
Managing Control - Governing BodyMedical Director Jan 1, 2025
Adp of the SNF Jan 1, 2025
Summerfield Development Company Organization, Santa Rosa, CA Corporation Adp of the SNF Jul 1, 2000
Chad Keetch Individual Corporate OfficerSecretary Ensign Services, Inc. Mar 1, 2011
Soon Burnam Individual Corporate OfficerSecretary Ensign Santa Rosa LLC Feb 1, 2006

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Aynna Y. Sae, MD
    • Internal Medicine Physician
    • Santa Rosa, CA
    • NPI 1598898942

    Adp of the SNF, Managing Control - Governing Body, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 12

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

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1121817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613520000000",
    "number": "1619976552",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1280 SUMMERFIELD RD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954057313",
            "telephone_number": "707-539-1515",
            "fax_number": "707-539-0630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1280 SUMMERFIELD RD",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954057313",
            "telephone_number": "707-539-1515",
            "fax_number": "707-539-0630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENSIGN SANTA ROSA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-20",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "949-540-1249",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CA",
            "license": "010000078",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZR06364J",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113833.3.1066.1",
            "affiliationName": "eSolutions Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Summerfield Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Summerfield Healthcare Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.