Active NPI
Health Services of Bluewater Bay, LLC
- Skilled Nursing Facility
- Niceville, FL
National Provider Identifier
1831593433
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- HEALTH SERVICES OF BLUEWATER BAY, LLC
- Practice address
- 1500 White Point Rd
Niceville, FL 32578-4249 - Phone
- (850) 897-5592
- Fax
- (850) 897-0501
- NPI assigned
- Oct 10, 2014
- 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. Sidney Duane Gallagher
- Title
- Member
- Phone
- (850) 830-6355
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | FL | Primary |
Addresses
Primary practice location
1500 White Point Rd
Niceville, FL 32578-4249
Mailing address
1500 White Point Rd
Niceville, FL 32578-4249
Phone (850) 897-5592
Other names 1
- The Manor at Blue Water Bay
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20141215000272 | FL | Part A Provider - Skilled Nursing Facility | 5496077844 | Practice locations: Niceville, FL |
Skilled nursing facility certification: CCN 105784
- Legal name
- HEALTH SERVICES OF BLUEWATER BAY LLC
- Doing business as
- THE MANOR AT BLUE WATER BAY
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF distinct part
- Participating since
- Feb 2, 1993
- Last certification
- Jan 15, 2025
- Beds
- 120
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC
- Incorporated
- Sep 10, 2014 in FL
- Enrollment address
- 1500 N. White Point Road
The Manor at Blue Water Bay
Niceville, FL 32578-4249 - Nursing home name
- MANOR AT BLUE WATER BAY, THE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Manor at Blue Water Bay, the
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Feb 2, 1993
- 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 |
|---|---|---|---|
| 10D0868968 | Manor at Blue Water Bay, the | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryNetworks
- Freedom Health HMO Network
- Optimum HealthCare HMO Network
Ownership & 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 |
|---|---|---|---|
| Matthew H Baltz | W-2 Managing Employee | Oct 31, 2014 | |
| Duane Gallagher | 5% Or Greater Direct Ownership Interest | Jan 1, 2015 | 100% |
| Corporate Officer | Jan 1, 2015 | 100% | |
| Corporate Director | Jan 1, 2015 | 100% |
Practitioners & affiliated clinicians
Affiliated clinicians 3
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Internal Medicine Physician
- Fort Walton Beach, FL
- NPI 1942285036
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1412899200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1412899200000",
"number": "1831593433",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 WHITE POINT RD",
"city": "NICEVILLE",
"state": "FL",
"postal_code": "325784249",
"telephone_number": "850-897-5592",
"fax_number": "850-897-0501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 WHITE POINT RD",
"city": "NICEVILLE",
"state": "FL",
"postal_code": "325784249",
"telephone_number": "850-897-5592",
"fax_number": "850-897-0501"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HEALTH SERVICES OF BLUEWATER BAY, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2014-10-10",
"last_updated": "2014-10-10",
"status": "A",
"authorized_official_last_name": "GALLAGHER",
"authorized_official_first_name": "SIDNEY",
"authorized_official_middle_name": "DUANE",
"authorized_official_title_or_position": "MEMBER",
"authorized_official_telephone_number": "850-830-6355",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "FL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "The Manor at Blue Water Bay",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Niceville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2014; 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.