NPIMap

Organization Active NPI

Otterbein Clearcreek, LLC

Doing business as Avalon by Otterbein Clear Creek

  • Skilled Nursing Facility
  • Centerville, OH
National Provider Identifier
1992977516
Registry record updated Feb 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
2518N Issued in OH
Legal business name
OTTERBEIN CLEARCREEK, LLC
Doing business as
Avalon by Otterbein Clear Creek
Practice address
9320 Avalon Circle
Centerville, OH 45458
Phone
(937) 885-5426
Fax
(937) 885-4969
NPI assigned
Mar 25, 2008
Last updated
Feb 9, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2015

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

Authorized official

Name
James Chris Green, CPA
Title
Treasurer & Cfo
Phone
(513) 933-5418

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X
Skilled Nursing Facility 314000000X 2518N OH Primary

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 1

  • Avalon by Otterbein Clear Creek Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080724000571 OH Part A Provider - Skilled Nursing Facility 8123191038 Practice locations: Centerville, OH

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992977516. Details of each certification follow.

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
LLCNon-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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Otterbein SpringboroCCN 366368 · All quality measures
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
ActiveFrom the Provider of Services file
Certified beds
6057.3 residents per day on average
Chain
Otterbein Seniorlife20 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D1086388Otterbein Clearcreek LLC9320 Avalon Circle, Centerville, OH 45458Certificate of waiverJul 10, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Becky Bayliff Individual Operational/Managerial Control Dec 1, 2021
Polaris Pharmacy Services of Ohio LLC Organization, Columbus, OH LLC, Medical provider/supplier, Consulting firm, For-profit Adp of the SNF Dec 1, 2018
Jason E Miller Individual Corporate OfficerChief Operating Officer Aug 4, 2014
Heidi Glosser Individual Operational/Managerial Control Dec 1, 2021
Susan Berner Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 1, 2025
Victoria Bartlett Individual Operational/Managerial Control Dec 1, 2021
William Brownson Individual Operational/Managerial Control Dec 1, 2021
Tomas Hazelbaker Individual Operational/Managerial Control Dec 1, 2021
Ralph Reed Fraley Individual Operational/Managerial Control Dec 1, 2021
Functional Pathways of Tennessee LLC Organization, Knoxville, TN Corporation, LLC, Medical provider/supplier, Medical staffing company Operational/Managerial Control Dec 1, 2018
Adp of the SNF Apr 4, 2025
Otterbein Neighborhoods, LLC Organization, Lebanon, OH LLC, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2016 100%
Jill Wilson Individual Corporate OfficerPresident & Ceo May 1, 2009
Otterbein Home Organization, Lebanon, OH Corporation, Non-profit, Chain home office 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 Individual Corporate OfficerVP Neighborhoods Sep 3, 2018
James Christopher Green Individual Corporate OfficerVP Finance/Cfo/Treasurer Nov 21, 2005 100%
Operational/Managerial Control Dec 1, 2021
Robert Coleman Individual Operational/Managerial Control Dec 1, 2021
Kristen McKinney Individual Operational/Managerial Control Aug 29, 2024
Adp of the SNF Apr 6, 2025
Daniel Burke Individual Operational/Managerial Control Dec 1, 2021
Lynn App Individual Operational/Managerial Control Dec 1, 2021
Steve Vonderhaar Individual Operational/Managerial Control Dec 1, 2021

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 27

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

View all 27

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 1

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": "1206403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423440000000",
    "number": "1992977516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 N STATE ROUTE 741",
            "city": "LEBANON",
            "state": "OH",
            "postal_code": "450368839",
            "telephone_number": "513-933-5401",
            "fax_number": "513-932-1054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9320 AVALON CIRCLE",
            "city": "CENTERVILLE",
            "state": "OH",
            "postal_code": "45458",
            "telephone_number": "937-885-5426",
            "fax_number": "937-885-4969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTTERBEIN CLEARCREEK, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-03-25",
        "last_updated": "2015-02-09",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "CHRIS",
        "authorized_official_title_or_position": "TREASURER & CFO",
        "authorized_official_telephone_number": "513-933-5418",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "OH",
            "license": "2518N",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avalon by Otterbein Clear Creek",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centerville, OH

Sources for this page

Verify at the official NPI Registry.