Active NPI
Bayberry Nursing Home
- Skilled Nursing Facility
- New Rochelle, NY
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 5904317N
- Legal business name
- BAYBERRY NURSING HOME
- Practice address
- 40 Keogh LN
New Rochelle, NY 10805-1308 - Phone
- (914) 636-6200
- Fax
- (914) 636-5125
- NPI assigned
- Jun 22, 2005
- 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. Leonard Russ
- Title
- Administrator
- Phone
- (914) 636-6200
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 5904317N | NY | Primary |
Addresses
Primary practice location
40 Keogh LN
New Rochelle, NY 10805-1308
Mailing address
40 Keogh LN
New Rochelle, NY 10805-1308
Phone (914) 636-6200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00420397 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111214000336 | NY | Part A Provider - Skilled Nursing Facility | 1456526862 | Practice locations: New Rochelle, NY |
Skilled nursing facility certification: CCN 335614
- Legal name
- BAYBERRY NURSING HOME
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 1, 1978
- Last certification
- May 30, 2023
- Beds
- 60
- Ownership / control type
- Partnership
- Organization structure
- Partnership
- Incorporated
- in NY
- Enrollment address
- 40 Keogh LN
New Rochelle, NY 10805-1308 - Nursing home name
- BAYBERRY NURSING HOME
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Bayberry Nursing Home
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Partnership
- Certified
- Jan 1, 1978
- Medicare certification status
- Active
- Certified beds
- 60
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 |
|---|---|---|---|
| 33D2197421 | Bayberry Nursing Home | Certificate of waiver | Mar 26, 2027 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 2
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 |
|---|---|---|---|
| Linda M Russ | General Partnership Interest | May 11, 2004 | 1% |
| Leonard Russ | 5% Or Greater Direct Ownership Interest | Jul 1, 1994 | 99% |
| General Partnership Interest | May 11, 2004 | 99% | |
| Operational/Managerial Control | Apr 17, 1986 | 100% |
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Geriatric Medicine (Internal Medicine) Physician
- Bronx, NY
- NPI 1962514034
-
- Internal Medicine Physician
- Bronx, NY
- NPI 1942393343
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": "1119398400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1750387916",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "40 KEOGH LN",
"city": "NEW ROCHELLE",
"state": "NY",
"postal_code": "108051308",
"telephone_number": "914-636-6200",
"fax_number": "914-636-5125"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 KEOGH LN",
"city": "NEW ROCHELLE",
"state": "NY",
"postal_code": "108051308",
"telephone_number": "914-636-6200",
"fax_number": "914-636-5125"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BAYBERRY NURSING HOME",
"organizational_subpart": "NO",
"enumeration_date": "2005-06-22",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "RUSS",
"authorized_official_first_name": "LEONARD",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "914-636-6200",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "NY",
"license": "5904317N",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00420397",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}
Other providers in New Rochelle, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.