Marshall Drive Opco LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

MARSHALL DRIVE OPCO LLC

Doing business as

Aviata at Big Bend

Practice address

207 Marshall Dr
Perry, FL 32347-1835

Phone

(850) 584-6334

Fax

(850) 838-1801

NPI assigned

Jul 14, 2023

Last updated

Apr 9, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Nathan Freund

Title

Manager

Phone

(732) 730-7480

Specialties & licenses 1

Addresses

Other names 1

• Aviata at Big Bend Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851070023. Details of each certification follow.

• CCN 105631 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 105631

Legal name

MARSHALL DRIVE OPCO LLC

Doing business as

AVIATA AT BIG BEND

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Dec 21, 1988

Last certification

Dec 18, 2024

Beds

120

Ownership / control type

Corporation

Multi-facility organization

Aviata Health Group

Organization structure

LLCProprietary

Incorporated

Jul 5, 2023 in FL

Enrollment address

207 Marshall Dr
Perry, FL 32347-1835

Nursing home name

AVIATA AT BIG BEND

Affiliated entity

AVIATA HEALTH GROUP

Listed as

Aviata at Big BendCCN 105631 · All quality measures

Overall star rating

1 of 5

Health inspections

1 of 5

Staffing

4 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Dec 21, 1988

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

12066.4 residents per day on average

Chain

Aviata Health Group50 facilities in the chain

Special focus status

SFF Candidate

Abuse citation

Cited for abuse (Care Compare abuse icon)

Penalties (3 years)

2Fines totaling $150,655

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 9

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.

• Joelle M Innocent-Simon, D.O.

  • Family Medicine Physician
  • Starke, FL
  • NPI 1205970134

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Affiliated clinicians 1

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

• Joelle M Innocent-Simon, D.O.

  • Family Medicine Physician
  • Starke, FL
  • NPI 1205970134

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1689292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744156800000",
    "number": "1851070023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 MARSHALL DR",
            "city": "PERRY",
            "state": "FL",
            "postal_code": "323471835",
            "telephone_number": "850-584-6334",
            "fax_number": "850-838-1801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 MARSHALL DR",
            "city": "PERRY",
            "state": "FL",
            "postal_code": "323471835",
            "telephone_number": "850-584-6334",
            "fax_number": "850-838-1801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARSHALL DRIVE OPCO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-14",
        "last_updated": "2025-04-09",
        "certification_date": "2025-04-09",
        "status": "A",
        "authorized_official_last_name": "FREUND",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "732-730-7480"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://65.196.137.118:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "urn:oid:2.16.840.1.113883.3.5042",
            "affiliationName": "Consulate Health Care",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "850 Concourse Pkwy S Ste 250",
            "city": "Maitland",
            "state": "FL",
            "country_code": "US",
            "postal_code": "327516155",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Aviata at Big Bend",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amanda Danielle Lukens, COTA
• Suzette H Lunan
• Duyen My Luu
• Christopher M Lynn, D.C.
• Robert Michael Lynn, P.T.
• Kinzi Mattingly, RN
• Laura McAninch, RBT
• Ashley Wambolt McCormick, FNP-C
• Stephanie N McCranie
• Genevieve Blanchard McGowan, C.R.N.A.

• Skilled Nursing Facility in Perry, FL
• Providers in Perry, FL by specialty
• Skilled Nursing Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2025; 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.