NPIMap

Organization Active NPI

Martin LM LLC

Doing business as Martin Luther Care Center

  • Skilled Nursing Facility
  • Bloomington, MN
National Provider Identifier
1629148929
Registry record updated Aug 3, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
343053 Issued in MN
Legal business name
MARTIN LM LLC
Doing business as
Martin Luther Care Center
Practice address
1401 E 100TH St
Bloomington, MN 55425
Phone
(952) 888-7751
Fax
(952) 698-3626
NPI assigned
Nov 8, 2006
Last updated
Aug 3, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
MARTIN LM LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 3, 2009

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

Authorized official

Name
Denver Kaufman
Title
President
Phone
(612) 371-0053

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 343053 MN Primary

Addresses

Primary practice location

1401 E 100TH St
Bloomington, MN 55425

Mailing address

1401 E 100TH St
Bloomington, MN 55425
Phone (952) 888-7751

Other identifiers 4

IdentifierTypeStateIssuer
8606MAOtherMNBLUE CROSS BLUE SHIELD
NH0033OtherMNUCARE
180482000MedicaidMN
71-22647OtherMNMEDICA

Other names 1

  • Martin Luther Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070219000561 MN Part A Provider - Skilled Nursing Facility 7911009147 Practice locations: Bloomington, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629148929. Details of each certification follow.

Skilled nursing facility certification: CCN 245272

Legal name
MARTIN LM LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Feb 1, 1985
Last certification
Apr 18, 2024
Beds
137
Ownership / control type
Corporation
Organization structure
LLCProprietary
Incorporated
Oct 30, 2006 in MN
Enrollment address
1401 E 100TH St
Bloomington, MN 55425-2615
Nursing home name
MARTIN LUTHER CARE CENTER
Affiliated entity
EBENEZER SENIOR LIVING

Care Compare: Nursing home

Medicare Care Compare
Listed as
Martin Luther Care CenterCCN 245272 · All quality measures
Overall star rating
2 of 5
Health inspections
1 of 5
Staffing
5 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Feb 1, 1985
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
137124.4 residents per day on average
Chain
Ebenezer Senior Living6 facilities in the chain
Penalties (3 years)
2Fines totaling $20,625

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
24D0402186Martin Luther Care Center1401 E 100TH St, Bloomington, MN 55425Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Martin LM LLC5 organizations share this tax ID, including this one
Part of
Martin LM LLC

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the 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
Gregory Terry McNellis Individual 5% Or Greater Indirect Ownership InterestPresident Jan 1, 2007 33.33%
Corporate OfficerSole Governor May 25, 2015 100%
Corporate DirectorPresident, Chief Manager, Assist May 25, 2015 100%
Daniel J Stein Individual Operational/Managerial Control Jan 1, 2015
Adp of the SNF Apr 21, 2025
Todd Willett Individual Operational/Managerial Control Oct 24, 2016
Ebenezer Management Services Inc Organization, Edina, MN Corporation, Management services company, For-profit Operational/Managerial Control Jan 1, 2007 100%
Adp of the SNF Jan 30, 2025
Angeline a Schnobrich Individual 5% Or Greater Indirect Ownership InterestIndirect Owner/Sole Truestee May 25, 2015 33.33%
Trustee of the SNF Jan 1, 2020
Roger W Schnobrich Revocable Trust U/a November 7, 2013 Organization, Wayzata, MN 5% Or Greater Indirect Ownership Interest May 25, 2015 33.33%
Mackenzie Christopher Individual Operational/Managerial Control Aug 6, 2018
Adp of the SNF Apr 21, 2025
Martin LM LLC Organization, Bloomington, MN LLC, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jan 1, 2007 100%
Adp of the SNF Jan 1, 2007
Denver Kaufman Revocable Trust U/a Dated 06/07/2004, Restated 07/25/20 Organization, Wayzata, MN 5% Or Greater Indirect Ownership Interest Mar 17, 2014 33.33%

Owners & managing parties with NPI records 2

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

Facilities with the same owner 7

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

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 4

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": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1249257600000",
    "number": "1629148929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 E 100TH ST",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "55425",
            "telephone_number": "952-888-7751",
            "fax_number": "952-698-3626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 E 100TH ST",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "55425",
            "telephone_number": "952-888-7751",
            "fax_number": "952-698-3626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN LM LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARTIN LM LLC",
        "enumeration_date": "2006-11-08",
        "last_updated": "2009-08-03",
        "status": "A",
        "authorized_official_last_name": "KAUFMAN",
        "authorized_official_first_name": "DENVER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "612-371-0053"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "343053",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "8606MA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "NH0033",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "180482000",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "71-22647",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Martin Luther Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bloomington, MN

Sources for this page

Verify at the official NPI Registry.