Jefferson City Manor Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

017299 Issued in MO

Legal business name

JEFFERSON CITY MANOR INC

Doing business as

Jefferson City Manor Care Center

Practice address

1720 Vieth Dr
Jefferson City, MO 65109-2056

Phone

(573) 635-6193

Fax

(573) 659-8925

NPI assigned

Sep 13, 2006

Last updated

Nov 23, 2016By 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

Benjamin C. Scheulen

Title

Ceo

Phone

(573) 556-6240

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jefferson City Manor Care Center Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962507459. Details of each certification follow.

• CCN 265285 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 265285

Legal name

JEFFERSON CITY MANOR INC

Doing business as

JEFFERSON CITY MANOR CARE CENTER

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Aug 22, 1985

Last certification

May 8, 2025

Beds

102

Ownership / control type

Corporation

Organization structure

CorporationProprietary

Enrollment address

1720 Vieth Dr
Jefferson City, MO 65109-2056

Nursing home name

JEFFERSON CITY MANOR CARE CENTER

Listed as

Jefferson City Manor Care CenterCCN 265285 · All quality measures

Overall star rating

1 of 5

Health inspections

3 of 5

Staffing

1 of 5

Quality measures

1 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Aug 22, 1985

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

10268.7 residents per day on average

Penalties (3 years)

1Fines totaling $8,340

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 3

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

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Garry D Pearson, D.O.

  • Family Medicine Physician
  • Jefferson City, MO
  • NPI 1629011812
  NPD (past)
• Kurt T Schultz, MD

  • General Practice Physician
  • Columbia, MO
  • NPI 1750394300
  NPD (past)
• Catherine M Vanvoorn, M.D.

  • Internal Medicine Physician
  • Columbia, MO
  • NPI 1720054448
  NPD (past)

Affiliated clinicians 4

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

• Joseph Charles Rakestraw, D.O.

  • Family Medicine Physician
  • Jefferson City, MO
  • NPI 1922002864

  Nursing home

  Care Compare affiliation
• Kurt T Schultz, MD

  • General Practice Physician
  • Columbia, MO
  • NPI 1750394300

  Nursing home

  Care Compare affiliation
• Emily Lou Drury, APN

  • Psychiatric/Mental Health Nurse Practitioner
  • Colorado Springs, CO
  • NPI 1659889319

  Nursing home

  Care Compare affiliation
• Lenora Ann Levin

  • Clinical Social Worker
  • Herrin, IL
  • NPI 1093227613

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479859200000",
    "number": "1962507459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 VIETH DR",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651092056",
            "telephone_number": "573-635-6193",
            "fax_number": "573-659-8925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 VIETH DR",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651092056",
            "telephone_number": "573-635-6193",
            "fax_number": "573-659-8925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON CITY MANOR INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2016-11-23",
        "status": "A",
        "authorized_official_last_name": "SCHEULEN",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "573-556-6240"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "017299",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102159605",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jefferson City Manor Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• JCMG Mental Health, L.L.C. (Jane Domke, PhD)
• JCMG Surgery Center, Inc.
• Theodule Jean Baptiste, MD
• Jefferson City Apothecary LLC (Jefferson City Apothecary)
• Jefferson City Foot & Ankle Clinic, LLC
• Jefferson City Medical Group, P.C. (Express Care- Elm Court)
• Jefferson City Medical Group, P.C. (Jefferson City Orthopaedics)
• Jefferson City Medical Group, P.C. (JCMG Hematology/Oncology)
• Jefferson City Medical Group, P.C. (JCMG Women's Clinic)
• Jefferson City Medical Group, P.C.

• Skilled Nursing Facility in Jefferson City, MO
• Providers in Jefferson City, MO by specialty
• Skilled Nursing Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2016; 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.