Ignite Medical Resort Fort Worth LLC

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

Legal business name

IGNITE MEDICAL RESORT FORT WORTH LLC

Practice address

6301 Oakmont Blvd
Fort Worth, TX 76132-2814

Phone

(682) 312-8577

NPI assigned

May 20, 2022

Organization subpart

No

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

Authorized official

Name

Timothy Fields

Title

Manager

Phone

(630) 327-2951

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Skilled nursing facility certification: CCN 676449

Legal name

IGNITE MEDICAL RESORT FORT WORTH, LLC

Certification status

Active

Provider type (POS)

Nursing home – SNF (Medicare) only

Participating since

Jun 21, 2018

Last certification

Nov 7, 2024

Beds

70

Ownership / control type

Corporation

Multi-facility organization

Ignite Medical Resorts

Organization structure

LLCProprietary

Incorporated

Nov 30, 2021 in TX

Enrollment address

6301 Oakmont Blvd
Fort Worth, TX 76132-2814

Nursing home name

IGNITE MEDICAL RESORT FORT WORTH, LLC

Affiliated entity

IGNITE MEDICAL RESORTS

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Ignite Medical Resort Fort Worth, LLC

  • Skilled Nursing Facility
  • Fort Worth, TX
  • NPI 1659031268

  O20220413000459

  Same enrollment

Listed as

Ignite Medical Resort Fort Worth, LLCCCN 676449

Overall star rating

2 of 5

Health inspections

1 of 5

Staffing

2 of 5

Quality measures

5 of 5

Type

Medicare

Ownership

For profit - Corporation

Certified

Jun 21, 2018

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

7048.2 residents per day on average

Chain

Ignite Medical Resorts22 facilities in the chain

Penalties (3 years)

6Fines totaling $141,703

Processed by Care Compare on Aug 1, 2026.

Tax ID family

Ignite Medical Resort Fort Worth2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Ignite Medical Resort Fort Worth, LLC

  • Skilled Nursing Facility
  • Fort Worth, TX
  • NPI 1659031268
  NPD tax ID

All disclosed owners & managing parties 30

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

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Richard Kent Niles, MD

  • Family Medicine Physician
  • Dallas, TX
  • NPI 1598714040

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Soroush Behnam, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Dallas, TX
  • NPI 1710908744

  Nursing home

  Care Compare affiliation
• Ryan Silvera, MD

  • Family Medicine Physician
  • McAllen, TX
  • NPI 1699129973

  Nursing home

  Care Compare affiliation
• Lily N Tran, DO

  • Family Medicine Physician
  • Fort Worth, TX
  • NPI 1265489330

  Nursing home

  Care Compare affiliation
• Alexandra Villacres, MD

  • Internal Medicine Physician
  • Weatherford, TX
  • NPI 1972659555

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1653004800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653004800000",
    "number": "1831837889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1550 N NORTHWEST HWY STE 430",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600681461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6301 OAKMONT BLVD",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761322814",
            "telephone_number": "682-312-8577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IGNITE MEDICAL RESORT FORT WORTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-20",
        "last_updated": "2022-05-20",
        "certification_date": "2022-05-20",
        "status": "A",
        "authorized_official_last_name": "FIELDS",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "630-327-2951"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamshid H Ighani, D.O.
• Maha Ighanifard, DO
• Ebuwa Ighodaro, MD
• Kim A Iglesia, MD
• Jose L Iglesias, MD
• Ignite Medical Resort Fort Worth, LLC
• Michael Omoregie Igori, RN
• Susan Kamarachukwume Ihekweme
• IHS Hospice LLC
• Demvihin Udokanma Ihyembe, M.D

• Rehabilitation Clinic/Center in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Rehabilitation Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2022; 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.

Verify at the official NPI Registry.