Active NPI
BC SNF, LLC
Doing business as Buffalo Crossings Healthcare and Rehabilitation Center
- Skilled Nursing Facility
- The Villages, FL
National Provider Identifier
1740949122
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- BC SNF, LLC
- Doing business as
- Buffalo Crossings Healthcare and Rehabilitation Center
- Practice address
- 3875 Wedgewood LN
The Villages, FL 32162-9301 - Phone
- (352) 674-4800
- NPI assigned
- Dec 13, 2021
- 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. Kevin Ryan Rockefeller
- Title
- Owner
- Phone
- (904) 422-5231
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
3875 Wedgewood LN
The Villages, FL 32162-9301
Mailing address
200 Clearwater Largo Rd S
Largo, FL 33770-3235
Phone (727) 581-4607
Other names 1
- Buffalo Crossings Healthcare and Rehabilitation Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220304002265 | FL | Part A Provider - Skilled Nursing Facility | 5193119212 | Practice locations: The Villages, FL |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1740949122. Details of each certification follow.
Skilled nursing facility certification: CCN 106114
- Legal name
- BC SNF, LLC
- Doing business as
- BUFFALO CROSSINGS HEALTHCARE AND REHABILITATION CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Sep 1, 2017
- Last certification
- Apr 17, 2024
- Beds
- 120
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC
- Incorporated
- Dec 21, 2000 in FL
- Enrollment address
- 3875 Wedgewood LN
The Villages, FL 32162-9301 - Nursing home name
- BUFFALO CROSSINGS HEALTHCARE & REHABILITATION CEN
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Buffalo Crossings Healthcare & Rehabilitation Cen
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Sep 1, 2017
- Medicare certification status
- Active
- Certified beds
- 120
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D2123988 | Buffalo Crossing Healthcare & Rehabilitation Ctr | Certificate of waiver | Jan 5, 2027 |
National Provider Directory
National Provider DirectoryNetworks
- Optimum HealthCare HMO Network
- Freedom Health 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 |
|---|---|---|---|
| Wedgewood Lane Investments, LLC | 5% Or Greater Direct Ownership Interest | Jan 1, 2022 | 28% |
| KR Management, LLC | Operational/Managerial Control | Jan 1, 2022 | 100% |
| Todd Martin | W-2 Managing Employee | Jan 1, 2022 | 100% |
| Daniel Hollenbeck | 5% Or Greater Direct Ownership Interest | Jan 1, 2022 | 15% |
| Kevin Rockefeller | 5% Or Greater Direct Ownership Interest | Jan 1, 2022 | 34% |
| Joshua Ohair | 5% Or Greater Direct Ownership Interest | Jan 1, 2022 | 20% |
Facilities with the same owner 2
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Chatham Glen Healthcare and Rehabilitation Center
- Skilled Nursing Facility
- The Villages, FL
- NPI 1639719081
KR Management, LLC
Practitioners & affiliated clinicians
Affiliated clinicians 6
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Geriatric Medicine (Internal Medicine) Physician
- The Villages, FL
- NPI 1265444202
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1639353600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1639353600000",
"number": "1740949122",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 CLEARWATER LARGO RD S",
"city": "LARGO",
"state": "FL",
"postal_code": "337703235",
"telephone_number": "727-581-4607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3875 WEDGEWOOD LN",
"city": "THE VILLAGES",
"state": "FL",
"postal_code": "321629301",
"telephone_number": "352-674-4800"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BC SNF, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2021-12-13",
"last_updated": "2021-12-13",
"certification_date": "2021-12-13",
"status": "A",
"authorized_official_last_name": "ROCKEFELLER",
"authorized_official_first_name": "KEVIN",
"authorized_official_middle_name": "RYAN",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "904-422-5231",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Buffalo Crossings Healthcare and Rehabilitation Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in The Villages, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2021; 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.