Cross-source identifiers
Every current identifier attachment, with the link method and confidence carried verbatim — deterministic links are 1.000; probabilistic links surface their real matcher confidence, never rounded up.
| Scheme | Value | Source table | Link method | Confidence | Since | Provenance |
|---|---|---|---|---|---|---|
| npi | 1073500831 | nppes_providers | deterministic_pk | 1.000 | 2026-06-10 | evidencerecorded: 2026-06-10 methodology: entity-graph/v1 evidence: {"rule":"D-NPI","source_pk":"1073500831","entity_type_code":"2"} |
| pac_id | 0547365355 | pecos_providers | exact_npi_in_pecos | 1.000 | 2026-06-16 | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 evidence: {"npi":"1073500831","rule":"D-PECOS","enrlmt_id":"O20070423000379","pecos_asct_cntl_id":"0547365355"} |
| pecos_enrlmt_id | O20070423000379 | pecos_providers | exact_npi_in_pecos | 1.000 | 2026-06-16 | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 evidence: {"npi":"1073500831","rule":"D-PECOS","enrlmt_id":"O20070423000379"} |
Graph edges
One-hop relationships — ownership, chain membership, operation — each backed by a federal source row.
| Relationship | Entity | Confidence | Source table | Provenance |
|---|---|---|---|---|
| ← owns | RICHARD J DAVIS | 1.000 | snf_all_owners | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 attributes: {"role_code":"43","association_date":"01/01/1997","percentage_ownership":null} evidence: {"rule":"D-OWNER","owner_pac":"0244746592","source_pk":48266,"type_owner":"I","enrollment_id":"O20070423000379","role_code_owner":"43","role_text_owner":"OPERATIONAL/MANAGERIAL CONTROL","dst_resolved_via":"pecos_enrlmt_id","percentage_ownership_raw":null,"enrollment_organization_name":"SHADESCREST HEALTH CARE CENTER"} |
| ← owns | OWNER PAC 1052827300 | 1.000 | snf_all_owners | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 attributes: {"role_code":"72","association_date":"01/01/2024","percentage_ownership":null} evidence: {"rule":"D-OWNER","owner_pac":"1052827300","source_pk":48268,"type_owner":"I","enrollment_id":"O20070423000379","role_code_owner":"72","role_text_owner":"ADP OF THE SNF","dst_resolved_via":"pecos_enrlmt_id","percentage_ownership_raw":null,"enrollment_organization_name":"SHADESCREST HEALTH CARE CENTER"} |
| ← owns | BETHANY M TIDWELL | 1.000 | snf_all_owners | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 attributes: {"role_code":"43","association_date":"05/01/2012","percentage_ownership":null} evidence: {"rule":"D-OWNER","owner_pac":"1254847502","source_pk":48269,"type_owner":"I","enrollment_id":"O20070423000379","role_code_owner":"43","role_text_owner":"OPERATIONAL/MANAGERIAL CONTROL","dst_resolved_via":"pecos_enrlmt_id","percentage_ownership_raw":null,"enrollment_organization_name":"SHADESCREST HEALTH CARE CENTER"} |
| ← owns | OWNER PAC 1557877800 (GA) | 1.000 | snf_all_owners | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 attributes: {"role_code":"72","association_date":"06/04/2025","percentage_ownership":null} evidence: {"rule":"D-OWNER","owner_pac":"1557877800","source_pk":48271,"type_owner":"O","enrollment_id":"O20070423000379","role_code_owner":"72","role_text_owner":"ADP OF THE SNF","dst_resolved_via":"pecos_enrlmt_id","percentage_ownership_raw":null,"enrollment_organization_name":"SHADESCREST HEALTH CARE CENTER"} |
| ← owns | JANET KING | 1.000 | snf_all_owners | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 attributes: {"role_code":"34","association_date":"05/18/2018","percentage_ownership":50} evidence: {"rule":"D-OWNER","owner_pac":"1850791021","source_pk":48272,"type_owner":"I","enrollment_id":"O20070423000379","role_code_owner":"34","role_text_owner":"5% OR GREATER DIRECT OWNERSHIP INTEREST","dst_resolved_via":"pecos_enrlmt_id","percentage_ownership_raw":50,"enrollment_organization_name":"SHADESCREST HEALTH CARE CENTER"} |
| ← owns | JERRY STOUT | 1.000 | snf_all_owners | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 attributes: {"role_code":"34","association_date":"05/18/2018","percentage_ownership":50} evidence: {"rule":"D-OWNER","owner_pac":"2466557285","source_pk":48274,"type_owner":"I","enrollment_id":"O20070423000379","role_code_owner":"34","role_text_owner":"5% OR GREATER DIRECT OWNERSHIP INTEREST","dst_resolved_via":"pecos_enrlmt_id","percentage_ownership_raw":50,"enrollment_organization_name":"SHADESCREST HEALTH CARE CENTER"} |
| ← owns | OWNER PAC 2466968714 (AL) | 1.000 | snf_all_owners | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 attributes: {"role_code":"72","association_date":"06/08/2025","percentage_ownership":null} evidence: {"rule":"D-OWNER","owner_pac":"2466968714","source_pk":48278,"type_owner":"O","enrollment_id":"O20070423000379","role_code_owner":"72","role_text_owner":"ADP OF THE SNF","dst_resolved_via":"pecos_enrlmt_id","percentage_ownership_raw":null,"enrollment_organization_name":"SHADESCREST HEALTH CARE CENTER"} |
| ← owns | ROBERT CHESTER MUMPOWER | 1.000 | snf_all_owners | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 attributes: {"role_code":"43","association_date":"11/16/2015","percentage_ownership":90} evidence: {"rule":"D-OWNER","owner_pac":"2769882935","source_pk":48279,"type_owner":"I","enrollment_id":"O20070423000379","role_code_owner":"43","role_text_owner":"OPERATIONAL/MANAGERIAL CONTROL","dst_resolved_via":"pecos_enrlmt_id","percentage_ownership_raw":90,"enrollment_organization_name":"SHADESCREST HEALTH CARE CENTER"} |
| ← owns | JEAN FRYE | 1.000 | snf_all_owners | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 attributes: {"role_code":"43","association_date":"05/01/2020","percentage_ownership":null} evidence: {"rule":"D-OWNER","owner_pac":"2961918214","source_pk":48281,"type_owner":"I","enrollment_id":"O20070423000379","role_code_owner":"43","role_text_owner":"OPERATIONAL/MANAGERIAL CONTROL","dst_resolved_via":"pecos_enrlmt_id","percentage_ownership_raw":null,"enrollment_organization_name":"SHADESCREST HEALTH CARE CENTER"} |
| ← owns | OWNER PAC 3375059629 (AL) | 1.000 | snf_all_owners | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 attributes: {"role_code":"72","association_date":"12/01/2014","percentage_ownership":null} evidence: {"rule":"D-OWNER","owner_pac":"3375059629","source_pk":48283,"type_owner":"O","enrollment_id":"O20070423000379","role_code_owner":"72","role_text_owner":"ADP OF THE SNF","dst_resolved_via":"pecos_enrlmt_id","percentage_ownership_raw":null,"enrollment_organization_name":"SHADESCREST HEALTH CARE CENTER"} |
| ← owns | BOYDE HARRISON (AL) | 1.000 | snf_all_owners | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 attributes: {"role_code":"43","association_date":"01/01/2023","percentage_ownership":null} evidence: {"rule":"D-OWNER","owner_pac":"3375445182","source_pk":48284,"type_owner":"I","enrollment_id":"O20070423000379","role_code_owner":"43","role_text_owner":"OPERATIONAL/MANAGERIAL CONTROL","dst_resolved_via":"pecos_enrlmt_id","percentage_ownership_raw":null,"enrollment_organization_name":"SHADESCREST HEALTH CARE CENTER"} |
| ← owns | OWNER PAC 4284140534 (AL) | 1.000 | snf_all_owners | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 attributes: {"role_code":"72","association_date":"06/08/2025","percentage_ownership":null} evidence: {"rule":"D-OWNER","owner_pac":"4284140534","source_pk":48286,"type_owner":"O","enrollment_id":"O20070423000379","role_code_owner":"72","role_text_owner":"ADP OF THE SNF","dst_resolved_via":"pecos_enrlmt_id","percentage_ownership_raw":null,"enrollment_organization_name":"SHADESCREST HEALTH CARE CENTER"} |
| ← owns | JENNIFER ESTILL | 1.000 | snf_all_owners | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 attributes: {"role_code":"43","association_date":"12/01/2015","percentage_ownership":null} evidence: {"rule":"D-OWNER","owner_pac":"4789190034","source_pk":48287,"type_owner":"I","enrollment_id":"O20070423000379","role_code_owner":"43","role_text_owner":"OPERATIONAL/MANAGERIAL CONTROL","dst_resolved_via":"pecos_enrlmt_id","percentage_ownership_raw":null,"enrollment_organization_name":"SHADESCREST HEALTH CARE CENTER"} |
| ← owns | OWNER PAC 4880100130 | 1.000 | snf_all_owners | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 attributes: {"role_code":"72","association_date":"12/01/2014","percentage_ownership":null} evidence: {"rule":"D-OWNER","owner_pac":"4880100130","source_pk":48289,"type_owner":"I","enrollment_id":"O20070423000379","role_code_owner":"72","role_text_owner":"ADP OF THE SNF","dst_resolved_via":"pecos_enrlmt_id","percentage_ownership_raw":null,"enrollment_organization_name":"SHADESCREST HEALTH CARE CENTER"} |
| ← owns | JOYCE A FREE | 1.000 | snf_all_owners | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 attributes: {"role_code":"43","association_date":"07/01/1990","percentage_ownership":null} evidence: {"rule":"D-OWNER","owner_pac":"4981110236","source_pk":48290,"type_owner":"I","enrollment_id":"O20070423000379","role_code_owner":"43","role_text_owner":"OPERATIONAL/MANAGERIAL CONTROL","dst_resolved_via":"pecos_enrlmt_id","percentage_ownership_raw":null,"enrollment_organization_name":"SHADESCREST HEALTH CARE CENTER"} |
| ← owns | OWNER PAC 5193231447 (OR) | 1.000 | snf_all_owners | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 attributes: {"role_code":"72","association_date":"06/08/2025","percentage_ownership":null} evidence: {"rule":"D-OWNER","owner_pac":"5193231447","source_pk":48292,"type_owner":"O","enrollment_id":"O20070423000379","role_code_owner":"72","role_text_owner":"ADP OF THE SNF","dst_resolved_via":"pecos_enrlmt_id","percentage_ownership_raw":null,"enrollment_organization_name":"SHADESCREST HEALTH CARE CENTER"} |
| ← owns | OWNER PAC 5698281947 | 1.000 | snf_all_owners | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 attributes: {"role_code":"72","association_date":"12/01/2014","percentage_ownership":null} evidence: {"rule":"D-OWNER","owner_pac":"5698281947","source_pk":48293,"type_owner":"I","enrollment_id":"O20070423000379","role_code_owner":"72","role_text_owner":"ADP OF THE SNF","dst_resolved_via":"pecos_enrlmt_id","percentage_ownership_raw":null,"enrollment_organization_name":"SHADESCREST HEALTH CARE CENTER"} |
| ← owns | NEXUS RESOURCE GROUP (TN) | 1.000 | snf_all_owners | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 attributes: {"role_code":"43","association_date":"03/01/2007","percentage_ownership":null} evidence: {"rule":"D-OWNER","owner_pac":"5698870418","source_pk":48294,"type_owner":"O","enrollment_id":"O20070423000379","role_code_owner":"43","role_text_owner":"OPERATIONAL/MANAGERIAL CONTROL","dst_resolved_via":"pecos_enrlmt_id","percentage_ownership_raw":null,"enrollment_organization_name":"SHADESCREST HEALTH CARE CENTER"} |
| ← owns | BRENDA SIMS | 1.000 | snf_all_owners | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 attributes: {"role_code":"43","association_date":"08/01/2023","percentage_ownership":null} evidence: {"rule":"D-OWNER","owner_pac":"5890201149","source_pk":48296,"type_owner":"I","enrollment_id":"O20070423000379","role_code_owner":"43","role_text_owner":"OPERATIONAL/MANAGERIAL CONTROL","dst_resolved_via":"pecos_enrlmt_id","percentage_ownership_raw":null,"enrollment_organization_name":"SHADESCREST HEALTH CARE CENTER"} |
| ← owns | TERRI L POLM | 1.000 | snf_all_owners | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 attributes: {"role_code":"43","association_date":"11/01/2021","percentage_ownership":null} evidence: {"rule":"D-OWNER","owner_pac":"6709392053","source_pk":48298,"type_owner":"I","enrollment_id":"O20070423000379","role_code_owner":"43","role_text_owner":"OPERATIONAL/MANAGERIAL CONTROL","dst_resolved_via":"pecos_enrlmt_id","percentage_ownership_raw":null,"enrollment_organization_name":"SHADESCREST HEALTH CARE CENTER"} |
| ← owns | MARK D WEST | 1.000 | snf_all_owners | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 attributes: {"role_code":"40","association_date":"05/01/2002","percentage_ownership":null} evidence: {"rule":"D-OWNER","owner_pac":"7012145790","source_pk":48300,"type_owner":"I","enrollment_id":"O20070423000379","role_code_owner":"40","role_text_owner":"CORPORATE OFFICER","dst_resolved_via":"pecos_enrlmt_id","percentage_ownership_raw":null,"enrollment_organization_name":"SHADESCREST HEALTH CARE CENTER"} |
| ← owns | SARAH J KOLB | 1.000 | snf_all_owners | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 attributes: {"role_code":"43","association_date":"05/01/2023","percentage_ownership":null} evidence: {"rule":"D-OWNER","owner_pac":"7517473861","source_pk":48303,"type_owner":"I","enrollment_id":"O20070423000379","role_code_owner":"43","role_text_owner":"OPERATIONAL/MANAGERIAL CONTROL","dst_resolved_via":"pecos_enrlmt_id","percentage_ownership_raw":null,"enrollment_organization_name":"SHADESCREST HEALTH CARE CENTER"} |
| ← owns | AMANDA G KENYON | 1.000 | snf_all_owners | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 attributes: {"role_code":"43","association_date":"09/01/2024","percentage_ownership":null} evidence: {"rule":"D-OWNER","owner_pac":"8426564774","source_pk":48305,"type_owner":"I","enrollment_id":"O20070423000379","role_code_owner":"43","role_text_owner":"OPERATIONAL/MANAGERIAL CONTROL","dst_resolved_via":"pecos_enrlmt_id","percentage_ownership_raw":null,"enrollment_organization_name":"SHADESCREST HEALTH CARE CENTER"} |
| ← owns | OWNER PAC 9234645581 | 1.000 | snf_all_owners | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 attributes: {"role_code":"72","association_date":"04/01/2024","percentage_ownership":null} evidence: {"rule":"D-OWNER","owner_pac":"9234645581","source_pk":48307,"type_owner":"I","enrollment_id":"O20070423000379","role_code_owner":"72","role_text_owner":"ADP OF THE SNF","dst_resolved_via":"pecos_enrlmt_id","percentage_ownership_raw":null,"enrollment_organization_name":"SHADESCREST HEALTH CARE CENTER"} |
| ← owns | KIMBERLY D MITCHELL KELLEY | 1.000 | snf_all_owners | evidencerecorded: 2026-06-16 methodology: entity-graph/v1 attributes: {"role_code":"43","association_date":"06/01/2011","percentage_ownership":null} evidence: {"rule":"D-OWNER","owner_pac":"9335655687","source_pk":48308,"type_owner":"I","enrollment_id":"O20070423000379","role_code_owner":"43","role_text_owner":"OPERATIONAL/MANAGERIAL CONTROL","dst_resolved_via":"pecos_enrlmt_id","percentage_ownership_raw":null,"enrollment_organization_name":"SHADESCREST HEALTH CARE CENTER"} |
Current record
Current claims returned for this entity, grouped by provenance subject. The table exposes the source identifier recorded for each claim.
org · 1073500831 JSON
| Metric | Value | Asserted | Source |
|---|---|---|---|
| enumeration_date | 2005-10-05 | 2026-06-10 | Centers for Medicare & Medicaid ServicesNPPES NPI Registry (individuals) 202602 publisher: Centers for Medicare & Medicaid Services retrieved: 2026-06-10 sha256: 8b5267e250fd4df6… claim API: JSON |
| legal_business_name | SHADESCREST HEALTH CARE CENTER | 2026-06-10 | Centers for Medicare & Medicaid ServicesNPPES NPI Registry (individuals) 202602 publisher: Centers for Medicare & Medicaid Services retrieved: 2026-06-10 sha256: 8b5267e250fd4df6… claim API: JSON |
| practice_state | AL | 2026-06-10 | Centers for Medicare & Medicaid ServicesNPPES NPI Registry (individuals) 202602 publisher: Centers for Medicare & Medicaid Services retrieved: 2026-06-10 sha256: 8b5267e250fd4df6… claim API: JSON |
| primary_taxonomy | 314000000X | 2026-06-10 | Centers for Medicare & Medicaid ServicesNPPES NPI Registry (individuals) 202602 publisher: Centers for Medicare & Medicaid Services retrieved: 2026-06-10 sha256: 8b5267e250fd4df6… claim API: JSON |
Provider screening signals
NPI-keyed source families read directly for 1073500831: federal and state integrity lists, CMS Open Payments, Order and Referring eligibility, Medicare opt-out, and enrollment revalidation. Cells expose the source and provenance fields supplied by the selected record. A screening aid — re-confirm any match against the primary source before acting; absence means nothing on file in the data Fonteum currently holds, never a guarantee none exists.
Sanctions & integrity
Coverage staleExclusion coverage is stale or cannot be reconciled to an attested source artifact. This result is indeterminate and must not be treated as a clearance; check the current issuing-agency lists.
- Coverage status: indeterminate
- Screened 26 integrity lists; no negative determination was made.
14-tuple provenance (26)
Industry payments
None on file0 CMS Open Payments records on file for this NPI.
14-tuple provenance (1)
Order & referring eligibility
None on fileNo CMS Order and Referring record on file for this NPI.
14-tuple provenance (1)
Medicare opt-out
None on fileNo CMS Medicare opt-out affidavit on file for this NPI.
14-tuple provenance (1)
Revalidation
On file1 Medicare enrollment record on file.
- Due date: TBD upstream — not due within the ensuing six months.
14-tuple provenance (1)
Point-in-time
Query retained claim coordinates under bitemporal-read/v1. Most facts have no superseded row; dates outside retained coverage may return no prior version, and diffs require both coordinates.
Pick a date to reconstruct, or two dates to diff. Equivalent JSON: /api/v1/history/{subject_type}/{subject_id}?at=… and …/diff?from=…&to=…