500 South Hospital Drive Operations LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

SNF130471012 Issued in FL

Legal business name

500 SOUTH HOSPITAL DRIVE OPERATIONS LLC

Doing business as

Shoal Creek Rehabilitation Center

Practice address

500 Hospital Dr
Crestview, FL 32539-7355

Phone

(850) 689-3146

Fax

(850) 689-2286

NPI assigned

Dec 22, 2011

Last updated

Nov 27, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kenneth Ussery Jr.

Title

VP

Phone

(407) 571-1550

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Shoal Creek Rehabilitation Center Doing business as

Electronic endpoints 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1324512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1689943458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 HOSPITAL DR",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325397355",
            "telephone_number": "850-689-3146",
            "fax_number": "850-689-2286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 HOSPITAL DR",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325397355",
            "telephone_number": "850-689-3146",
            "fax_number": "850-689-2286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "500 SOUTH HOSPITAL DRIVE OPERATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-12-22",
        "last_updated": "2023-11-27",
        "certification_date": "2020-05-18",
        "status": "A",
        "authorized_official_last_name": "USSERY",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "407-571-1550",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "FL",
            "license": "SNF130471012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005985200",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://65.196.137.118:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "urn:oid:2.16.840.1.113883.3.5042",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "800 Concourse Pkwy S Ste 200",
            "city": "Maitland",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327516148",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Shoal Creek Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shoal Creek Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Crestview, FL
• Providers in Crestview, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.