Bedrock HCS at Watertown LLC
Organization Active NPI Skilled Nursing Facility · Watertown, WI
NPI 1972154011 · NPPES record last updated Sep 20, 2019
Key facts
- NPI
- 1972154011
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- BEDROCK HCS AT WATERTOWN LLC
- Practice address
- 121 Hospital Dr
Watertown, WI 53098-3303 - Phone
- (920) 261-9220
- NPI assigned
- Sep 20, 2019
- Organization subpart
- No
Authorized official
- Name
- Esther Tillim
- Title
- Bookkeeper
- Phone
- (732) 328-7499
Owners & managing parties with NPI records 1
-
Sandeep R Ramanujam, M.D.
Facilities with the same owner 6
Practitioners 1
-
Sandeep R Ramanujam, M.D.
Affiliated clinicians 1
-
Sandeep R Ramanujam, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Watertown Health Care Center
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★☆☆☆☆ 1 of 5
- Staffing
- ★☆☆☆☆ 1 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Jul 1, 1983
- Medicare certification status
- Active
- Certified beds
- 112 · 74.0 residents per day on average
- Chain
- Bedrock Healthcare
- Special focus status
- SFF Candidate
- Penalties (3 years)
- 7 · fines totaling $278,229
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 52D0702268 | Bedrock HCS at Watertown LLC | Certificate of waiver | Jun 13, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Skilled nursing facility certification: CCN 525333
- Legal name
- BEDROCK HCS AT WATERTOWN LLC
- Doing business as
- WATERTOWN HEALTH CARE CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jul 1, 1983
- Last certification
- Nov 14, 2024
- Beds
- 112
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Bedrock HCS
- Most recent change of ownership
- Oct 1, 2019
- Organization structure
- LLC · Proprietary
- Incorporated
- Jun 28, 2019 in WI
- Enrollment address
- 121 Hospital Dr
Watertown, WI 53098-3303 - Nursing home name
- WATERTOWN HEALTH CARE CENTER
- Affiliated entity
- BEDROCK HEALTHCARE
All disclosed owners & managing parties 7
| Name | Role | Since | Share |
|---|---|---|---|
| Martin Chopp |
5% Or Greater Indirect Ownership Interest | Oct 1, 2019 | 20% |
| Adp of the SNF | Oct 1, 2019 | ||
| Bedrock HC Wi LLC |
5% Or Greater Direct Ownership Interest | Oct 1, 2019 | 100% |
| Sandeep R Ramanujam |
Operational/Managerial Control | Feb 1, 2024 | |
| Adp of the SNF | Feb 1, 2024 | ||
| Opal Healthcare Wi LLC |
Operational/Managerial Control | Oct 1, 2019 | |
| Adp of the SNF | Mar 27, 2025 | ||
| Solomon Chopp |
5% Or Greater Indirect Ownership Interest | Oct 1, 2019 | 20% |
| Adp of the SNF | Oct 1, 2019 | ||
| Pnina Chopp |
5% Or Greater Indirect Ownership Interest | Oct 1, 2019 | 60% |
| Adp of the SNF | Oct 1, 2019 | ||
| Raymond B Freson |
Operational/Managerial Control | Dec 24, 2024 | |
| Adp of the SNF | Dec 24, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191114003072 | WI | Part a Provider - Skilled Nursing Facility | 0648602565 | Practice locations: Watertown, WI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
121 Hospital Dr
Watertown, WI 53098-3303
Mailing address
Workspace at Bitbean C/O Esther Tillim
1776 Ave of the States Suite 302
Lakewood, NJ 08701
Phone (732) 328-4977
Other providers in Watertown, WI
- John Christopher Bass
- Brittany Batten
- Elizabeth Sarah Baumann
- Erik Dmitri Beaver
- Wendy M Becker
- Bruce S. Bencriscutto
- Cynthia Ann Bennett
- Kristine Elizabeth Bennett
- Leah Marie Benz
- Bethel Counseling & Consultation LLC
All providers in Watertown, WI · Skilled Nursing Facility in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 20, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.