NPIMap

Organization Active NPI

Waterman Communities Inc

Doing business as Waterman Village Home Care

  • Home Health Agency
  • Mount Dora, FL
National Provider Identifier
1750458709
Registry record updated Aug 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
299992505 Issued in FL
Legal business name
WATERMAN COMMUNITIES INC
Doing business as
Waterman Village Home Care
Practice address
445 Waterman Ave
Mount Dora, FL 32757-9518
Phone
(352) 383-0051
NPI assigned
Nov 28, 2006
Last updated
Aug 14, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2024

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

Authorized official

Name
Andrew Dujon
Title
President and Ceo
Phone
(352) 383-0051

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 299992505 FL Primary

Addresses

Primary practice location

445 Waterman Ave
Mount Dora, FL 32757-9518

Mailing address

250 Brookfield Ave
Mount Dora, FL 32757-9559

Other practice location 1

130 Waterman Ave
Mount Dora, FL 32757-9519
Phone (352) 385-1138

Other practice location 2

300 Brookfield Ave
Mount Dora, FL 32757-9562
Phone (352) 385-1124

Other names 1

  • Waterman Village Home Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081022000650 FL Part A Provider - Home Health Agency 9335207190 Practice locations: Mount Dora, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1750458709. Details of each certification follow.

Home health agency certification: CCN 109450

Legal name
WATERMAN COMMUNITIES, INC.
Doing business as
WATERMAN VILLAGE HOME CARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Nov 30, 2009
Last certification
Oct 19, 2015
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
Dec 22, 1987 in FL
Enrollment address
130 Waterman Ave.
Mount Dora, FL 32757-9518

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Home health agency

Medicare Care Compare
Listed as
Waterman Village Home CareCCN 109450 · All quality measures
Overall star rating
3 of 5
Ownership
Non-Profit
Certified
Nov 30, 2009
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

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
10D1048634Waterman Village Home Care130 Waterman Ave, Mount Dora, FL 32757Certificate of waiverDec 5, 2027

National Provider Directory

National Provider Directory
Tax ID family
Springwater at Waterman Village6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Máximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Ownership & related parties

All disclosed owners & managing parties 5

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Thomas Popieski Individual Corporate DirectorBoard of Directors Mar 1, 2010
Richard Leigh Individual Corporate DirectorBoard of Directors Nov 13, 1994
Kevin McEwen Individual Corporate Director Sep 12, 2008
Andrew Dujon Individual Corporate Officer Dec 8, 2008
W-2 Managing Employee Sep 12, 2008
Heardley Murdock Individual Corporate OfficerCfo Oct 1, 2018

Practitioners & affiliated clinicians

Affiliated clinicians 12

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": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723593600000",
    "number": "1750458709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 BROOKFIELD AVE",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327579559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 WATERMAN AVE",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327579518",
            "telephone_number": "352-383-0051"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "130 Waterman Ave",
            "address_purpose": "LOCATION",
            "city": "Mount Dora",
            "state": "FL",
            "postal_code": "327579519",
            "country_code": "US",
            "telephone_number": "352-385-1138",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "300 Brookfield Ave",
            "address_purpose": "LOCATION",
            "city": "Mount Dora",
            "state": "FL",
            "postal_code": "327579562",
            "country_code": "US",
            "telephone_number": "352-385-1124",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WATERMAN COMMUNITIES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A",
        "authorized_official_last_name": "DUJON",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "352-383-0051"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "FL",
            "license": "299992505",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waterman Village Home Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Dora, FL

Sources for this page

Verify at the official NPI Registry.