Ignite Medical Resort Round Rock LLC

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

Legal business name

IGNITE MEDICAL RESORT ROUND ROCK LLC

Practice address

16219 Ranch Road 620 N
Austin, TX 78717-5209

Phone

(512) 520-1834

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 676440

Legal name

IGNITE MEDICAL RESORT ROUND ROCK, LLC

Certification status

Active

Provider type (POS)

Nursing home – SNF (Medicare) only

Participating since

Feb 21, 2018

Last certification

Oct 16, 2024

Beds

70

Ownership / control type

Limited Liability Corporation

Multi-facility organization

Ignite

Organization structure

LLCProprietary

Incorporated

Nov 30, 2021 in TX

Enrollment address

16219 Ranch Road 620 N
Austin, TX 78717-5209

Nursing home name

IGNITE MEDICAL RESORT ROUND ROCK, 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 Round Rock, LLC

  • Skilled Nursing Facility
  • Austin, TX
  • NPI 1710647326

  O20220406001589

  Same enrollment

Listed as

Ignite Medical Resort Round Rock, LLCCCN 676440

Overall star rating

2 of 5

Health inspections

1 of 5

Staffing

3 of 5

Quality measures

5 of 5

Type

Medicare

Ownership

For profit - Limited Liability company

Certified

Feb 21, 2018

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

7057.6 residents per day on average

Chain

Ignite Medical Resorts22 facilities in the chain

Penalties (3 years)

4Fines totaling $63,733

Processed by Care Compare on Aug 1, 2026.

Tax ID family

Ignite Medical Resort Round Rock2 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 Round Rock, LLC

  • Skilled Nursing Facility
  • Austin, TX
  • NPI 1710647326
  NPD tax ID

Locations

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.

• Anil Rathi, M.D.

  • Internal Medicine Physician
  • Austin, TX
  • NPI 1215321492

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Affiliated clinicians 4

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

• Michael Joseph Gutierrez, MD

  • Internal Medicine Physician
  • Austin, TX
  • NPI 1174810048

  Nursing home

  Care Compare affiliation
• Anil Rathi, M.D.

  • Internal Medicine Physician
  • Austin, TX
  • NPI 1215321492

  Nursing home

  Care Compare affiliation
• John Salas

  • Internal Medicine Physician
  • Round Rock, TX
  • NPI 1801812649

  Nursing home

  Care Compare affiliation
• Samira Shahnaz

  • Internal Medicine Physician
  • Austin, TX
  • NPI 1134495575

  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": "1992443949",
    "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": "16219 RANCH ROAD 620 N",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787175209",
            "telephone_number": "512-520-1834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IGNITE MEDICAL RESORT ROUND ROCK 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": []
}

• Kimberly Elizabeth Idoko, M.D.
• Haley Idrogo
• Francisca Ada Ifesinachukwu, M.D.
• Martha Iglehart
• Ignite Adventures LLC
• Ignite Medical Resort Round Rock, LLC
• Ignite Performance Physical Therapy LLC
• Mona Iguchi, MD, CSSD
• Olivia Chinonso Iheanacho
• Steffan Ihegboro, DPT

• All providers in Austin, TX
• 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.