Otterbein Clearcreek, LLC
Organization Active NPI Skilled Nursing Facility · Centerville, OH
NPI 1992977516 · NPPES record last updated Feb 9, 2015
Key facts
- NPI
- 1992977516
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 2518N (OH)
- Legal business name
- OTTERBEIN CLEARCREEK, LLC
- Practice address
- 9320 Avalon Circle
Centerville, OH 45458 - Phone
- (937) 885-5426
- Fax
- (937) 885-4969
- NPI assigned
- Mar 25, 2008
- Organization subpart
- No
Authorized official
- Name
- James Chris Green, CPA
- Title
- Treasurer & Cfo
- Phone
- (513) 933-5418
Owners & managing parties with NPI records 2
-
Susan Elaine Berner, M.D.
Facilities with the same owner 27
Practitioners 2
-
Sally Caraballo, D.P.M.
Affiliated clinicians 1
Medicare Care Compare: Nursing home
- Listed as
- Otterbein Springboro
- 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
- Non profit - Corporation
- Certified
- Nov 10, 2008
- Medicare certification status
- Active
- Certified beds
- 60 · 57.3 residents per day on average
- Chain
- Otterbein Seniorlife
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 36D1086388 | Otterbein Clearcreek LLC | Certificate of waiver | Jul 10, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Skilled nursing facility certification: CCN 366368
- Legal name
- OTTERBEIN CLEARCREEK LLC
- Doing business as
- OTTERBEIN CLEARCREEK
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Nov 10, 2008
- Last certification
- Oct 18, 2022
- Beds
- 60
- Ownership / control type
- Nonprofit Corporation
- Multi-facility organization
- Otterbein Senior Life
- Organization structure
- LLC · Non-profit
- Incorporated
- Aug 18, 2007 in OH
- Enrollment address
- 9320 Avalon Cir
Centerville, OH 45458-4989 - Nursing home name
- OTTERBEIN SPRINGBORO
- Affiliated entity
- OTTERBEIN SENIORLIFE
All disclosed owners & managing parties 20
| Name | Role | Since | Share |
|---|---|---|---|
| Becky Bayliff |
Operational/Managerial Control | Dec 1, 2021 | |
| Polaris Pharmacy Services of Ohio LLC |
Adp of the SNF | Dec 1, 2018 | |
| Jason E Miller |
Corporate Officer |
Aug 4, 2014 | |
| Heidi Glosser |
Operational/Managerial Control | Dec 1, 2021 | |
| Susan Berner |
Operational/Managerial Control | Jan 1, 2025 | |
| Adp of the SNF | Jan 1, 2025 | ||
| Victoria Bartlett |
Operational/Managerial Control | Dec 1, 2021 | |
| William Brownson |
Operational/Managerial Control | Dec 1, 2021 | |
| Tomas Hazelbaker |
Operational/Managerial Control | Dec 1, 2021 | |
| Ralph Reed Fraley |
Operational/Managerial Control | Dec 1, 2021 | |
| Functional Pathways of Tennessee LLC |
Operational/Managerial Control | Dec 1, 2018 | |
| Adp of the SNF | Apr 4, 2025 | ||
| Otterbein Neighborhoods, LLC |
5% Or Greater Direct Ownership Interest | Jan 1, 2016 | 100% |
| Jill Wilson |
Corporate Officer |
May 1, 2009 | |
| Otterbein Home |
5% Or Greater Direct Ownership Interest | Dec 1, 2021 | 100% |
| 5% Or Greater Indirect Ownership Interest | Dec 1, 2021 | 100% | |
| Operational/Managerial Control | Dec 1, 2021 | ||
| Adp of the SNF | Dec 1, 2021 | ||
| Daniel Arnold |
Corporate Officer |
Sep 3, 2018 | |
| James Christopher Green |
Corporate Officer |
Nov 21, 2005 | 100% |
| Operational/Managerial Control | Dec 1, 2021 | ||
| Robert Coleman |
Operational/Managerial Control | Dec 1, 2021 | |
| Kristen McKinney |
Operational/Managerial Control | Aug 29, 2024 | |
| Adp of the SNF | Apr 6, 2025 | ||
| Daniel Burke |
Operational/Managerial Control | Dec 1, 2021 | |
| Lynn App |
Operational/Managerial Control | Dec 1, 2021 | |
| Steve Vonderhaar |
Operational/Managerial Control | Dec 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080724000571 | OH | Part a Provider - Skilled Nursing Facility | 8123191038 | Practice locations: Centerville, OH |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | |||
| Skilled Nursing Facility | 314000000X | 2518N | OH | Yes |
Addresses
Primary practice location
9320 Avalon Circle
Centerville, OH 45458
Mailing address
580 N State Route 741
Lebanon, OH 45036-8839
Phone (513) 933-5401
Other names
- Avalon by Otterbein Clear Creek
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All providers in Centerville, OH · Skilled Nursing Facility in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 9, 2015. 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.