NPIMap

Organization Active NPI

Blue Heron Health and Rehabilitation LLC

  • Skilled Nursing Facility
  • Wesley Chapel, FL
National Provider Identifier
1972193712
Registry record updated Apr 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
BLUE HERON HEALTH AND REHABILITATION LLC
Practice address
5085 Eagleston Boulevard
Wesley Chapel, FL 33544
Phone
(813) 454-0513
NPI assigned
Jan 26, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2021

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

Authorized official

Name
Beth R Klee
Title
Executive Assistant
Phone
(765) 664-5400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

5085 Eagleston Boulevard
Wesley Chapel, FL 33544

Mailing address

1800 N Wabash Rd
Marion, IN 46952-1300
Phone (765) 664-5400

Other names 2

  • Blue Heron Health and Rehabilitation Doing business as
  • Blue Heron Senior Living Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210224000148 FL Part A Provider - Skilled Nursing Facility 6800201906 Practice locations: Wesley Chapel, FL

Skilled nursing facility certification: CCN 106147

Legal name
BLUE HERON HEALTH AND REHABILITATION LLC
Doing business as
BLUE HERON HEALTH AND REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 12, 2021
Last certification
Apr 27, 2023
Beds
141
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Incorporated
Jun 28, 2017 in FL
Enrollment address
5085 Eagleston Blvd
Wesley Chapel, FL 33544-8877
Nursing home name
BLUE HERON HEALTH AND REHABILITATION
Affiliated entity
TLC MANAGEMENT

Care Compare: Nursing home

Medicare Care Compare
Listed as
Blue Heron Health and RehabilitationCCN 106147
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jul 12, 2021
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
141133.3 residents per day on average
Chain
TLC Management20 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Blue Heron Assisted Living2 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.

Networks

  • Freedom Health HMO NetworkPlans: Freedom Platinum Rewards Plan Rx (HMO) (H5427-102-000, H5427); Freedom VIP Care (HMO C-SNP) (H5427-070-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-108-000, H5427); Freedom VIP Rewards (HMO C-SNP) (H5427-099-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-107-000, H5427); Freedom Maximo (HMO-POS) (H5427-113-000, H5427); Freedom Savings Plan (HMO) (H5427-052-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-096-000, H5427); Freedom Platinum Rewards Plan Rx (HMO) (H5427-105-000, H5427); Freedom Medi-Medi Full (HMO D-SNP) (H5427-087-000, H5427)…
  • Optimum HealthCare HMO NetworkPlans: Optimum Diamond Rewards (HMO C-SNP) (H5594-028-000, H5594); Optimum Diamond (HMO C-SNP) (H5594-036-000, H5594); Optimum Diamond Rewards (HMO C-SNP) (H5594-034-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-029-000, H5594); Optimum Platinum Plan (HMO) (H5594-002-000, H5594); Optimum Gold Plus Plan (HMO) (H5594-032-000, H5594); Optimum Diamond Savings COPD (HMO C-SNP) (H5594-031-000, H5594); Optimum Diamond Savings (HMO C-SNP) (H5594-030-000, H5594); Optimum Diamond Rewards COPD (HMO C-SNP) (H5594-035-000, H5594)

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Ryan Ott Individual 5% Or Greater Direct Ownership InterestMember Jun 28, 2017 13%
Corporate OfficerMember Jun 28, 2017 13%
Ott Family Trust Organization, Marion, IN 5% Or Greater Direct Ownership Interest Jun 28, 2017 15%
Gary L Ott Individual 5% Or Greater Direct Ownership InterestPresident Jun 28, 2017 52%
Corporate OfficerPresident Jun 28, 2017 52%
Dwight a Ott Individual 5% Or Greater Direct Ownership InterestSecretary/Treasurer Jun 28, 2017 10%
Corporate OfficerSecretary/Treasurer Jun 28, 2017 10%
Kimberly a Smith Individual Corporate DirectorExecutive Director Nov 30, 2020 100%
W-2 Managing EmployeeExecutive Director Nov 30, 2020 100%
Tender Loving Care Management Inc Organization, Marion, IN Corporation Operational/Managerial Control Jun 28, 2017 100%

Facilities with the same owner 19

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 19

Practitioners & affiliated clinicians

Affiliated clinicians 4

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

NPI Registry JSON

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

{
    "created_epoch": "1611619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617667200000",
    "number": "1972193712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 N WABASH RD",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469521300",
            "telephone_number": "765-664-5400",
            "fax_number": "765-664-5403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5085 EAGLESTON BOULEVARD",
            "city": "WESLEY CHAPEL",
            "state": "FL",
            "postal_code": "33544",
            "telephone_number": "813-454-0513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLUE HERON HEALTH AND REHABILITATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-26",
        "last_updated": "2021-04-06",
        "certification_date": "2021-04-06",
        "status": "A",
        "authorized_official_last_name": "KLEE",
        "authorized_official_first_name": "BETH",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "EXECUTIVE ASSISTANT",
        "authorized_official_telephone_number": "765-664-5400"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Heron Health and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Blue Heron Senior Living",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Wesley Chapel, FL

Sources for this page

Verify at the official NPI Registry.