provider rate component data report(nf) : effective date ......2021/01/01  · 0041672 hamilton 1-s...

42
0001938 Noble 3-S 100.55 56.84 9.54 1.32 1.04 0010302 Fulton 2-L 117.19 61.15 10.17 0.00 1.56 0024637 Franklin 2-L 117.05 61.15 10.17 2.77 2.08 0025690 Cuyahoga 2-L 106.94 61.15 10.17 0.01 1.56 0025725 Wayne 3-S 112.05 56.84 9.54 0.00 2.08 0025761 Mahoning 2-S 117.27 63.85 10.79 0.00 1.56 0025789 Summit 2-S 88.83 63.85 10.79 0.05 1.56 0025850 Ashland 3-L 115.69 57.68 7.99 2.01 1.04 0030246 Cuyahoga 2-L 131.44 61.15 10.17 4.84 3.12 0030700 Adams 3-S 117.29 56.84 9.54 1.83 2.60 0030773 Cuyahoga 2-L 133.64 61.15 10.17 3.83 2.08 0034288 Hamilton 1-S 119.92 61.65 10.50 0.04 2.08 0034297 Franklin 2-L 97.73 61.15 10.17 0.04 1.04 0034322 Franklin 2-S 101.98 63.85 10.79 0.00 1.04 0034359 Geauga 2-S 118.88 63.85 10.79 3.07 3.64 0034395 Butler 1-L 95.10 58.99 11.11 0.03 2.08 0035527 Hamilton 1-S 128.96 61.65 10.50 0.00 1.56 0039514 Jefferson 3-S 99.19 56.84 9.54 0.76 2.08 0040226 Geauga 2-S 114.92 63.85 10.79 2.52 1.04 199.64 19 Ohman Family Living At Briar 16.44 -1.79 0.00 10.41 218.18 18 Catherine'S Care Center, Inc. 16.44 -1.79 0.00 16.58 197.26 17 Beechwood Home 16.44 -1.79 0.00 15.51 232.83 16 Mount Pleasant Retirement Village 16.44 -1.79 0.00 15.30 202.94 15 Ohman Family Living At Holly 16.44 -1.79 0.00 15.09 229.97 14 Wexner Heritage House 16.44 -1.79 0.00 10.63 221.38 13 Ohio Living Westminster-Thurber 16.44 -1.79 0.00 5.95 190.73 12 Llanfair Retirement Community 16.44 -1.79 0.00 12.54 215.93 11 Pleasantview Care Center 16.44 -1.79 0.00 13.81 239.33 10 Adams County Manor 16.44 -1.79 0.00 13.18 212.87 9 Broadview Multi-Care Center 16.44 -1.79 0.00 14.03 239.40 8 Good Shepherd Home (The) 16.44 -1.79 0.00 13.81 222.15 7 Ohio Living Rockynol 16.44 -1.79 0.00 10.84 190.57 6 Jewish Home For The Aged 16.44 -1.79 0.00 14.03 207.23 5 West View Healthy Living 16.44 -1.79 0.00 9.56 204.72 4 The Montefiore Home 16.44 -1.79 0.00 12.75 217.47 3 Monterey Care Center 16.44 -1.79 0.00 0.00 207.87 2 Fairlawn Haven 16.44 -1.79 0.00 12.75 Add-On Total Rate 1 Summit Acres Nursing Home 16.44 -1.79 0.00 9.99 193.93 Capital Rate Tax Rate Qlty Add- On Qlty Deduc- tion Critical Acc Fac Add-On Qlty Incen Rate Provider Rate Component Data Report(NF) : Effective Date - 01/01/2021 as of 5-5-21 Cnt Provider Number Provider Name County Ancillary/ Support Peer Group Direct Rate Ancillary/ Support Rate

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Page 1: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0001938 Noble 3-S 100.55 56.84 9.54 1.32 1.04

0010302 Fulton 2-L 117.19 61.15 10.17 0.00 1.56

0024637 Franklin 2-L 117.05 61.15 10.17 2.77 2.08

0025690 Cuyahoga 2-L 106.94 61.15 10.17 0.01 1.56

0025725 Wayne 3-S 112.05 56.84 9.54 0.00 2.08

0025761 Mahoning 2-S 117.27 63.85 10.79 0.00 1.56

0025789 Summit 2-S 88.83 63.85 10.79 0.05 1.56

0025850 Ashland 3-L 115.69 57.68 7.99 2.01 1.04

0030246 Cuyahoga 2-L 131.44 61.15 10.17 4.84 3.12

0030700 Adams 3-S 117.29 56.84 9.54 1.83 2.60

0030773 Cuyahoga 2-L 133.64 61.15 10.17 3.83 2.08

0034288 Hamilton 1-S 119.92 61.65 10.50 0.04 2.08

0034297 Franklin 2-L 97.73 61.15 10.17 0.04 1.04

0034322 Franklin 2-S 101.98 63.85 10.79 0.00 1.04

0034359 Geauga 2-S 118.88 63.85 10.79 3.07 3.64

0034395 Butler 1-L 95.10 58.99 11.11 0.03 2.08

0035527 Hamilton 1-S 128.96 61.65 10.50 0.00 1.56

0039514 Jefferson 3-S 99.19 56.84 9.54 0.76 2.08

0040226 Geauga 2-S 114.92 63.85 10.79 2.52 1.04

199.64

19 Ohman Family Living At Briar 16.44 -1.79 0.00 10.41 218.18

18 Catherine'S Care Center, Inc. 16.44 -1.79 0.00 16.58

197.26

17 Beechwood Home 16.44 -1.79 0.00 15.51 232.83

16 Mount Pleasant Retirement Village 16.44 -1.79 0.00 15.30

202.94

15 Ohman Family Living At Holly 16.44 -1.79 0.00 15.09 229.97

14 Wexner Heritage House 16.44 -1.79 0.00 10.63

221.38

13 Ohio Living Westminster-Thurber 16.44 -1.79 0.00 5.95 190.73

12 Llanfair Retirement Community 16.44 -1.79 0.00 12.54

215.93

11 Pleasantview Care Center 16.44 -1.79 0.00 13.81 239.33

10 Adams County Manor 16.44 -1.79 0.00 13.18

212.87

9 Broadview Multi-Care Center 16.44 -1.79 0.00 14.03 239.40

8 Good Shepherd Home (The) 16.44 -1.79 0.00 13.81

222.15

7 Ohio Living Rockynol 16.44 -1.79 0.00 10.84 190.57

6 Jewish Home For The Aged 16.44 -1.79 0.00 14.03

207.23

5 West View Healthy Living 16.44 -1.79 0.00 9.56 204.72

4 The Montefiore Home 16.44 -1.79 0.00 12.75

217.47

3 Monterey Care Center 16.44 -1.79 0.00 0.00 207.87

2 Fairlawn Haven 16.44 -1.79 0.00 12.75

Add-On

Total

Rate

1 Summit Acres Nursing Home 16.44 -1.79 0.00 9.99 193.93

Capital

Rate

Tax

Rate

Qlty

Add-

On

Qlty

Deduc-

tion

Critical

Acc Fac

Add-On

Qlty

Incen

Rate

Provider Rate Component Data Report(NF) : Effective Date - 01/01/2021 as of 5-5-21

Cnt

Provider

Number Provider Name County

Ancillary/

Support

Peer Group

Direct Rate

Ancillary/

Support

Rate

Page 2: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0040879 Summit 2-S 118.19 63.85 10.79 1.59 1.56

0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60

0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08

0050912 Athens 3-L 111.82 57.68 7.99 6.28 2.08

0052804 Geauga 2-L 118.57 61.15 10.17 1.59 1.56

0053847 Marion 2-L 114.03 61.15 10.17 1.36 3.12

0054705 Cuyahoga 2-S 119.32 63.85 10.79 #### 2.08

0055368 Ashtabula 2-S 130.61 63.85 10.79 3.28 2.60

0055381 Stark 2-S 107.65 63.85 10.79 0.02 2.08

0055407 Wyandot 3-L 111.67 57.68 7.99 0.02 1.56

0057594 Mahoning 2-L 128.29 61.15 10.17 3.03 2.08

0058723 Columbiana 3-S 105.58 56.84 9.54 1.64 0.52

0059208 Vinton 3-S 103.19 56.84 9.54 1.15 2.60

0059690 Medina 2-L 129.13 61.15 10.17 2.37 2.60

0060897 Fayette 2-L 108.06 61.15 10.17 3.69 2.08

0061413 Summit 2-S 114.08 63.85 10.79 1.68 1.56

0061439 Montgomery 2-S 107.30 63.85 10.79 3.17 3.12

0061666 Hancock 2-L 116.31 61.15 10.17 1.85 2.08

0064329 Warren 1-S 120.25 61.65 10.50 2.93 2.60

0064343 Highland 3-S 123.27 56.84 9.54 1.43 3.12

0064489 Cuyahoga 2-S 115.30 63.85 10.79 0.00 2.08

0067809 Athens 3-S 108.15 56.84 9.54 1.82 2.08

0067835 Morgan 3-S 110.51 56.84 9.54 1.78 2.08 205.6042 Riverside Landing Nursing And

Rehabilitation, Inc.

16.44 -1.79 0.00 10.20

217.30

41 Arcadia Valley Skilled Nursing &

Rehabilitation, I

16.44 -1.79 0.00 7.86 200.94

40 Mount St. Joseph Rehab Center 16.44 -1.79 0.00 10.63

226.39

39 Crestwood Ridge Skilled Nursing

And Rehabilitation

16.44 -1.79 0.00 15.09 223.94

38 Pine Ridge Skilled Nursing And

Rehabilitation

16.44 -1.79 0.00 13.81

219.88

37 Fox Run Manor 16.44 -1.79 0.00 7.23 213.44

36 Astoria Health & Rehab Center 16.44 -1.79 0.00 17.00

215.10

35 Altercare Of Cuyahoga Falls Ctr

For Rehab/Nur Care

16.44 -1.79 0.00 0.00 206.61

34 Court House Manor 16.44 -1.79 0.00 15.30

202.21

33 Willowood Care Center Of

Brunswick, Inc.

16.44 -1.79 0.00 16.58 236.65

32 Maple Hills Skilled Nursing And

Rehabilitation

16.44 -1.79 0.00 14.24

236.37

31 Valley Oaks Care Center 16.44 -1.79 0.00 0.00 188.77

30 Austinwoods Rehabilitation Health

Care Center

16.44 -1.79 0.00 17.00

213.49

29 Fairhaven Community 16.44 -1.79 0.00 8.93 202.50

28 Chapel Hill Community 16.44 -1.79 0.00 14.45

230.87

27 Geneva Shores Skilled Nursing

And Rehabilitation

16.44 -1.79 0.00 0.00 225.78

26 Oaks Of Brecksville 16.44 -1.79 0.00 8.93

220.65

25 Marion Manor 16.44 -1.79 0.00 0.00 204.48

24 Heather Hill Care Communities 16.44 -1.79 0.00 12.96

198.63

23 Laurels Of Athens (The) 16.44 -1.79 0.00 12.75 213.25

22 Rae-Ann Westlake 16.44 -1.79 0.00 0.00

222.96

21 Marjorie P. Lee Community 16.44 -1.79 0.00 0.00 191.41

20 Wayside Farms, Inc. 16.44 -1.79 0.00 12.33

Page 3: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0068593 Huron 3-S 100.91 56.84 9.54 1.73 2.08

0069349 Franklin 2-L 96.87 61.15 10.17 0.00 1.56

0069517 Ashland 3-S 105.26 56.84 9.54 1.18 2.60

0070062 Jefferson 3-S 118.01 56.84 9.54 2.74 3.12

0070085 Belmont 3-S 94.70 56.84 9.54 1.39 1.56

0070103 Hamilton 1-L 138.51 58.99 11.11 0.51 2.08

0071275 Lake 2-S 110.58 63.85 10.79 2.10 3.12

0071310 Cuyahoga 2-S 111.36 63.85 10.79 3.86 2.60

0072031 Fairfield 2-S 107.01 63.85 10.79 0.00 2.08

0072442 Lorain 2-L 125.02 61.15 10.17 3.93 2.08

0072991 Franklin 2-S 104.47 63.85 10.79 2.17 2.60

0072993 Allen 2-S 111.65 63.85 10.79 2.18 2.08

0073403 Summit 2-S 111.60 63.85 10.79 0.00 0.52

0073645 Hamilton 1-S 133.01 61.65 10.50 9.80 2.08

0073646 Summit 2-S 118.40 63.85 10.79 4.26 1.56

0075775 Franklin 2-L 119.81 61.15 10.17 4.44 2.60

0075815 Montgomery 2-L 110.95 61.15 10.17 5.35 1.56

0075825 Harrison 3-S 77.75 56.84 9.54 1.47 1.04

0076197 Lucas 2-S 127.22 63.85 10.79 3.08 2.08

0076444 Stark 2-S 126.62 63.85 10.79 2.19 1.04

0076601 Columbiana 3-S 117.34 56.84 9.54 1.08 2.08

0076796 Allen 2-S 100.11 63.85 10.79 0.00 1.04

0077098 Portage 2-S 110.36 63.85 10.79 5.76 2.08

201.92

65 Woodlands Health And

Rehabilitation Center

16.44 -1.79 0.00 13.60 221.09

64 Willow Ridge Of Mennonite Home

Communities Of Ohio

16.44 -1.79 0.00 11.48

234.87

63 Circle Of Care 16.44 -1.79 0.00 0.00 201.53

62 Jackson Ridge Rehabilitation And

Care Center

16.44 -1.79 0.00 15.73

174.04

61 The Lakes Of Monclova Health

Campus

16.44 -1.79 0.00 0.00 221.67

60 Sunnyslope Nursing Home 16.44 -1.79 0.00 12.75

222.38

59 Oaks Of West Kettering (The) 16.44 -1.79 0.00 0.00 203.83

58 Scioto Community 16.44 -1.79 0.00 9.56

247.20

57 Heritage Of Hudson 16.44 -1.79 0.00 14.66 228.17

56 Covenant Village Of Green

Township

16.44 -1.79 0.00 15.51

205.20

55 Concordia At Sumner 16.44 -1.79 0.00 10.63 212.04

54 Lost Creek Healthcare And

Rehabilitation Center

16.44 -1.79 0.00 0.00

228.48

53 Eastland Healthcare &

Rehabilitation Center

16.44 -1.79 0.00 11.26 209.79

52 Anchor Lodge Nursing Home 16.44 -1.79 0.00 11.48

223.69

51 Parkside At Wesley Ridge/Robert

A Barnes Center

16.44 -1.79 0.00 12.75 211.13

50 Walton Manor Health Care Center 16.44 -1.79 0.00 16.58

252.25

49 Homestead Ii 16.44 -1.79 0.00 15.94 221.03

48 Lincoln Crawford Care Center 16.44 -1.79 10.46 15.94

222.54

47 Sienna Hills Nursing And

Rehabilitation, Inc.

16.44 -1.79 0.00 14.88 193.56

46 Sienna Skilled Nursing And

Rehabilitation, Inc.

16.44 -1.79 0.00 17.64

184.40

45 Crystal Care Center Of Ashland 16.44 -1.79 0.00 17.85 207.92

44 National Church Residences First

Community Village

16.44 -1.79 0.00 0.00

43 The Willows At Willard 16.44 -1.79 0.00 12.96 198.71

Page 4: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0077107 Clark 2-S 103.70 63.85 10.79 5.41 1.56

0077293 Jefferson 3-S 107.48 56.84 9.54 2.25 2.08

0077576 Clark 2-S 117.10 63.85 10.79 3.72 2.08

0078544 Summit 2-S 113.53 63.85 10.79 4.47 3.12

0079825 Lucas 2-S 106.82 63.85 10.79 0.56 1.56

0080055 Medina 2-S 126.55 63.85 10.79 6.61 3.12

0083367 Carroll 3-S 103.67 56.84 9.54 1.04 1.56

0087551 Montgomery 2-S 120.43 63.85 10.79 5.31 1.04

0088456 Summit 2-S 131.34 63.85 10.79 4.37 1.56

0088787 Montgomery 2-S 119.15 63.85 10.79 2.55 1.56

0088876 Huron 3-S 112.63 56.84 9.54 1.50 2.60

0090282 Franklin 2-S 124.08 63.85 10.79 3.35 2.08

0090507 Stark 2-S 96.06 63.85 10.79 0.93 1.56

0091495 Clermont 1-S 136.59 61.65 10.50 5.40 1.04

0091571 Fayette 2-S 87.84 63.85 10.79 0.27 2.60

0092820 Delaware 2-S 108.54 63.85 10.79 2.14 1.56

0093528 Fayette 2-S 109.92 63.85 10.79 1.45 2.08

0093677 Crawford 3-S 102.85 56.84 9.54 1.45 3.12

0093786 Muskingum 3-S 96.01 56.84 9.54 2.49 1.56

0093953 Cuyahoga 2-S 123.20 63.85 10.79 3.80 1.04

0094291 Muskingum 3-S 96.70 56.84 9.54 1.43 2.60

0094445 Wood 2-S 92.98 63.85 10.79 0.00 3.12

0095766 Mahoning 2-S 111.09 63.85 10.79 1.62 2.60 217.9988 Park Center Health Care And

Rehabilitation Center

16.44 -1.79 0.00 13.39

198.34

87 St. Clare Commons 16.44 -1.79 0.00 17.00 202.39

86 The Oaks At Bethesda 16.44 -1.79 0.00 16.58

194.48

85 Royal Oak Nursing &

Rehabilitation Center

16.44 -1.79 0.00 15.30 232.63

84 The Oaks At Northpointe 16.44 -1.79 0.00 13.39

202.74

83 Signature Healthcare Of Galion 16.44 -1.79 0.00 14.24 202.69

82 Signature Healthcare Of Fayette

County

16.44 -1.79 0.00 0.00

190.63

81 Wintersong Village 16.44 -1.79 0.00 9.35 210.88

80 Four Seasons Of Washington

Nursing And Rehab

16.44 -1.79 0.00 10.63

187.84

79 The Atlantes 16.44 -1.79 0.00 0.00 229.83

78 Roselawn Gardens Nursing &

Rehabilitation

16.44 -1.79 0.00 0.00

216.89

77 Forest Hills Center 16.44 -1.79 0.00 14.66 233.46

76 The Laurels Of New London 16.44 -1.79 0.00 19.13

226.56

75 The Laurels Of West Carrollton 16.44 -1.79 0.00 13.60 226.15

74 The Briarwood 16.44 -1.79 0.00 0.00

203.24

73 The Laurels Of Huber Heights 16.44 -1.79 0.00 11.48 227.55

72 Bowerston Hills 16.44 -1.79 0.00 15.94

206.73

71 Avenue At Medina 16.44 -1.79 0.00 9.99 235.56

70 Merit House Senior Community 16.44 -1.79 0.00 8.50

227.07

69 Bath Creek Estates 16.44 -1.79 0.00 11.69 222.10

68 Dayview Care Center 16.44 -1.79 0.00 14.88

217.60

67 Villa Vista Royale Llc 16.44 -1.79 0.00 9.14 201.98

66 Forest Glen Health Campus 16.44 -1.79 0.00 17.64

Page 5: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0096322 Montgomery 2-S 100.94 63.85 10.79 4.22 2.60

0096324 Butler 1-S 111.89 61.65 10.50 3.67 1.56

0096325 Hamilton 1-S 103.75 61.65 10.50 2.10 1.04

0096419 Trumbull 2-S 89.17 63.85 10.79 1.45 3.12

0098672 Washington 3-S 105.44 56.84 9.54 1.44 2.60

0098759 Hamilton 1-L 107.42 58.99 11.11 6.29 2.08

0100320 Hamilton 1-S 97.37 61.65 10.50 6.43 1.04

0100325 Hamilton 1-S 85.43 61.65 10.50 1.68 2.08

0100666 Franklin 2-L 98.28 61.15 10.17 6.29 0.52

0101855 Mercer 3-S 76.35 56.84 9.54 0.00 2.08

0105843 Clermont 1-S 121.99 61.65 10.50 2.38 3.12

0107272 Scioto 3-S 101.66 56.84 9.54 1.43 2.08

0107636 Scioto 3-S 98.86 56.84 9.54 1.43 2.08

0108006 Lake 2-L 118.64 61.15 10.17 2.29 2.08

0108292 Coshocton 3-S 98.19 56.84 9.54 1.22 3.12

0108312 Ross 2-L 109.73 61.15 10.17 1.39 3.12

0108606 Lucas 2-S 101.22 63.85 10.79 2.70 1.56

0108619 Cuyahoga 2-L 108.13 61.15 10.17 3.68 2.60

0110260 Franklin 2-S 115.00 63.85 10.79 1.96 2.08

0110265 Sandusky 2-S 104.13 63.85 10.79 1.96 1.56

0111742 Summit 2-L 112.02 61.15 10.17 0.16 1.56

0112671 Darke 2-S 131.88 63.85 10.79 1.96 1.56

0113309 Columbiana 3-S 97.93 56.84 9.54 1.43 1.04

237.23

111 The Orchards Of East Liverpool 16.44 -1.79 0.00 8.29 189.72

110 Village Green Health Campus 16.44 -1.79 0.00 12.54

210.12

109 Heartland Of Twinsburg 16.44 -1.79 0.00 12.33 212.04

108 Elmwood Assisted Living And

Skilled Nursing Of Fremont

16.44 -1.79 0.00 13.18

216.32

107 Otterbein New Albany 16.44 -1.79 0.00 11.26 219.59

106 Willow Park Convalescent Home 16.44 -1.79 0.00 15.94

216.15

105 Park Terrace Nursing And

Rehabilitation Center

16.44 -1.79 0.00 13.60 208.37

104 Signature Healthcare Of Chillicothe 16.44 -1.79 0.00 15.94

222.37

103 Signature Healthcare Of Coshocton 16.44 -1.79 0.00 0.00 183.56

102 Continuing Healthcare Of Mentor 16.44 -1.79 0.00 13.39

197.25

101 Crystal Care Center Of Franklin

Furnace

16.44 -1.79 0.00 12.75 196.15

100 Crystal Care Center Of Portsmouth 16.44 -1.79 0.00 11.05

159.46

99 Florentine Gardens 16.44 -1.79 0.00 15.09 229.38

98 Colonial Nursing Center Of

Rockford

16.44 -1.79 0.00 0.00

185.34

97 Heartland Of Dublin 16.44 -1.79 0.00 11.26 202.32

96 Courtyard At Seasons 16.44 -1.79 0.00 9.35

210.32

95 Wellspring Health Center 16.44 -1.79 0.00 0.00 191.64

94 Lakeridge Villa Healthcare Center 16.44 -1.79 0.00 9.78

199.82

93 Muskingum Skilled Nursing &

Rehabilitation

16.44 -1.79 0.00 17.43 207.94

92 Washington Square Healthcare

Center

16.44 -1.79 0.00 16.79

211.15

91 Diversicare Of St. Theresa 16.44 -1.79 0.00 0.00 193.69

90 Diversicare Of Bradford Place 16.44 -1.79 0.00 7.23

89 Diversicare Of Siena Woods 16.44 -1.79 0.00 11.90 208.95

Page 6: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0114579 Putnam 3-S 98.55 56.84 9.54 1.43 2.60

0116557 Hamilton 1-S 117.90 61.65 10.50 2.04 1.04

0116558 Warren 1-S 98.30 61.65 10.50 2.04 2.08

0116753 Warren 1-S 142.32 61.65 10.50 2.04 1.04

0117319 Lorain 2-S 117.89 63.85 10.79 1.96 2.60

0118306 Montgomery 2-S 148.06 63.85 10.79 1.96 1.56

0118610 Clinton 1-S 137.27 61.65 10.50 2.04 2.60

0118752 Franklin 2-S 122.39 63.85 10.79 1.96 2.08

0118995 Summit 2-S 129.10 63.85 10.79 1.96 2.60

0119288 Montgomery 2-S 94.69 63.85 10.79 1.96 2.08

0119400 Columbiana 3-L 113.94 57.68 7.99 2.31 2.08

0120210 Montgomery 2-L 103.02 61.15 10.17 0.05 2.08

0121029 Cuyahoga 2-S 111.55 63.85 10.79 1.96 2.08

0121557 Hamilton 1-S 132.17 61.65 10.50 2.04 3.12

0121731 Cuyahoga 2-L 104.99 61.15 10.17 2.16 2.08

0122500 Geauga 2-L 130.38 61.15 10.17 2.16 3.12

0124001 Hamilton 1-S 113.85 61.65 10.50 0.00 2.08

0124010 Defiance 3-L 108.37 57.68 7.99 1.73 2.60

0125181 Franklin 2-L 120.70 61.15 10.17 2.16 2.08

0127900 Summit 2-S 106.71 63.85 10.79 0.15 2.08

0128067 Sandusky 2-S 121.12 63.85 10.79 1.96 2.08

0128069 Lucas 2-S 118.31 63.85 10.79 1.96 2.08

0128381 Hamilton 1-L 123.70 58.99 11.11 2.38 2.08 228.85134 Sanctuary Pointe Nursing & Rehab

Center

16.44 -1.79 0.00 15.94

214.45

133 Astoria Place Of Waterville Llc 16.44 -1.79 0.00 13.18 224.82

132 Astoria Place Of Clyde Llc 16.44 -1.79 0.00 0.00

225.57

131 Village At St. Edward Nursing

Care

16.44 -1.79 0.00 10.41 208.64

130 The Grand 16.44 -1.79 0.00 14.66

214.42

129 Laurels Of Defiance (The) 16.44 -1.79 0.00 12.11 205.13

128 Mt. Healthy Christian Home, Inc. 16.44 -1.79 0.00 11.69

207.53

127 Mapleview Country Villa 16.44 -1.79 0.00 15.94 237.57

126 Jennings Hall 16.44 -1.79 0.00 12.33

204.88

125 Liberty Nursing Center Of Colerain

Inc

16.44 -1.79 0.00 17.64 241.77

124 Gateway Health Care Center 16.44 -1.79 0.00 0.00

212.46

123 Mary Scott Nursing Center 16.44 -1.79 0.00 0.00 191.12

122 Calcutta Health Care Center 16.44 -1.79 0.00 13.81

238.46

121 Garden Court Nursing And

Rehabilitation Center

16.44 -1.79 0.00 15.09 203.11

120 Green Village Skilled Nursing &

Rehabilitation Ltd

16.44 -1.79 0.00 15.51

239.76

119 Otterbein Gahanna Skilled Nursing

And Rehab

16.44 -1.79 0.00 7.65 223.37

118 Oprs Communities Dba Cape May

Retirement Village

16.44 -1.79 0.00 11.05

228.74

117 Dunbar Health & Rehab Center 16.44 -1.79 0.00 0.00 240.87

116 The Woods On French Creek

Nursing & Rehabilitation Center

16.44 -1.79 0.00 17.00

204.31

115 Cedarview Care Center 16.44 -1.79 0.00 11.90 244.10

114 Cedars Of Lebanon Care Center 16.44 -1.79 0.00 15.09

198.06

113 Harrison Pavilion Care Center 16.44 -1.79 0.00 8.29 216.07

112 The Meadows Of Ottawa 16.44 -1.79 0.00 14.45

Page 7: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0130959 Greene 2-L 103.15 61.15 10.17 2.16 1.56

0131020 Ross 2-S 103.40 63.85 10.79 0.88 1.56

0132262 Cuyahoga 2-S 113.92 63.85 10.79 1.96 2.08

0133768 Portage 2-S 135.73 63.85 10.79 1.96 2.60

0135497 Madison 2-S 117.59 63.85 10.79 1.96 1.56

0135641 Lucas 2-S 146.73 63.85 10.79 1.96 1.04

0135646 Gallia 3-S 102.08 56.84 9.54 1.43 1.56

0135650 Clermont 1-L 123.67 58.99 11.11 2.38 1.04

0135655 Richland 3-S 103.62 56.84 9.54 1.43 1.56

0135656 Monroe 3-S 97.00 56.84 9.54 1.43 2.08

0135661 Washington 3-L 111.25 57.68 7.99 1.43 1.56

0135674 Clark 2-S 143.70 63.85 10.79 1.96 2.60

0135677 Lucas 2-S 123.96 63.85 10.79 1.96 1.56

0135689 Delaware 2-S 111.62 63.85 10.79 1.96 1.56

0135693 Fairfield 2-S 110.26 63.85 10.79 1.96 0.52

0135880 Washington 3-S 100.37 56.84 9.54 1.43 3.12

0135886 Carroll 3-S 102.97 56.84 9.54 1.43 3.64

0135892 Summit 2-S 104.74 63.85 10.79 1.96 2.60

0135895 Meigs 3-S 94.91 56.84 9.54 1.43 2.08

0135904 Madison 2-S 107.39 63.85 10.79 1.96 1.56

0135907 Summit 2-L 108.24 61.15 10.17 2.16 2.08

0135913 Portage 2-S 102.70 63.85 10.79 1.96 1.56

0135982 Cuyahoga 2-L 93.72 61.15 10.17 4.61 1.56

207.20

157 Slovene Home For The Aged 16.44 -1.79 0.00 4.46 190.32

156 Arbors At Streetsboro 16.44 -1.79 0.00 11.69

213.59

155 Arbors At Stow 16.44 -1.79 0.00 13.60 212.05

154 Arbors West 16.44 -1.79 0.00 13.39

207.94

153 Arbors At Pomeroy 16.44 -1.79 0.00 7.23 186.68

152 Arbors At Fairlawn 16.44 -1.79 0.00 9.35

197.43

151 Arbors At Minerva 16.44 -1.79 0.00 12.75 201.82

150 Harmar Place 16.44 -1.79 0.00 11.48

216.97

149 Arbors At Carroll 16.44 -1.79 0.00 12.11 214.14

148 Arbors At Delaware 16.44 -1.79 0.00 12.54

237.55

147 Arbors At Sylvania 16.44 -1.79 0.00 10.84 227.61

146 Arbors At Springfield 16.44 -1.79 0.00 0.00

197.05

145 Arbors At Marietta 16.44 -1.79 0.00 8.93 203.49

144 Arbors At Woodsfield 16.44 -1.79 0.00 15.51

220.77

143 Arbors At Mifflin 16.44 -1.79 0.00 14.03 201.67

142 Arbors At Milford 16.44 -1.79 0.00 8.93

239.02

141 Arbors At Gallipolis 16.44 -1.79 0.00 14.03 200.13

140 Arbors At Oregon 16.44 -1.79 0.00 0.00

245.31

139 London Health & Rehab Center 16.44 -1.79 0.00 13.18 223.58

138 Avenue At Aurora 16.44 -1.79 0.00 15.73

204.69

137 Eastbrook Healthcare Center 16.44 -1.79 0.00 12.54 219.79

136 Valley View Alzheimer'S Care

Center

16.44 -1.79 0.00 9.56

135 Village At The Greene 16.44 -1.79 0.00 8.71 201.55

Page 8: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0136507 Erie 3-S 107.15 56.84 9.54 0.21 2.08

0138671 Butler 1-L 131.18 58.99 11.11 2.38 1.04

0139693 Gallia 3-S 95.39 56.84 9.54 0.05 1.04

0140920 Lucas 2-S 111.64 63.85 10.79 1.96 2.08

0141167 Trumbull 2-S 116.34 63.85 10.79 1.96 1.04

0141168 Trumbull 2-S 114.96 63.85 10.79 1.96 2.08

0141341 Erie 3-S 103.93 56.84 9.54 1.43 0.52

0142869 Medina 2-S 116.90 63.85 10.79 1.96 1.04

0142884 Medina 2-S 114.43 63.85 10.79 1.96 2.60

0143263 Portage 2-L 122.80 61.15 10.17 2.16 3.64

0143287 Cuyahoga 2-S 121.18 63.85 10.79 1.96 1.56

0143550 Summit 2-S 113.45 63.85 10.79 1.96 1.56

0145091 Ashland 3-S 111.37 56.84 9.54 1.43 2.60

0145822 Clermont 1-S 127.82 61.65 10.50 2.04 2.08

0147479 Pickaway 2-S 120.25 63.85 10.79 1.82 2.08

0147488 Van Wert 3-S 110.37 56.84 9.54 1.68 1.56

0149527 Lucas 2-L 94.36 61.15 10.17 2.16 1.04

0151618 Cuyahoga 2-L 139.06 61.15 10.17 2.16 1.04

0152730 Hamilton 1-S 96.66 61.65 10.50 0.00 2.08

0153828 Hamilton 1-L 122.49 58.99 11.11 0.00 1.04

0154340 Erie 3-S 93.37 56.84 9.54 1.43 1.56

0154366 Trumbull 2-L 120.20 61.15 10.17 2.16 1.56

0154447 Mahoning 2-S 121.64 63.85 10.79 1.96 3.12 216.01180 Continuing Healthcare Of

Boardman

16.44 -1.79 0.00 0.00

193.97

179 Autumn Hills Care Center 16.44 -1.79 0.00 11.26 221.15

178 Continuing Healthcare Of Milan 16.44 -1.79 0.00 16.58

201.48

177 Daniel Drake Center For Post-

Acute Care

16.44 -1.79 0.00 0.00 208.28

176 Judson Care Center 16.44 -1.79 0.00 15.94

183.53

175 O'Neill Healthcare-Fairview Park 16.44 -1.79 0.00 15.73 243.96

174 Promedica Skilled Nursing And

Rehabilitation (Sylvania)

16.44 -1.79 0.00 0.00

230.23

173 Vancrest Health Care Center 16.44 -1.79 0.00 8.93 203.57

172 Pickaway Manor Care Center, Inc. 16.44 -1.79 0.00 16.79

210.46

171 Otterbein Union Township 16.44 -1.79 0.00 13.60 232.34

170 Brethren Care Village Health Care

Center

16.44 -1.79 0.00 14.03

227.59

169 Altercare Transitional Care Of The

Western Reserve, Inc.

16.44 -1.79 0.00 13.18 219.44

168 Highland Pointe Health &

Rehabilitation Center

16.44 -1.79 0.00 13.60

222.52

167 Longmeadow Care Center 16.44 -1.79 0.00 18.28 232.85

166 Sanctuary Medina Llc 16.44 -1.79 0.00 14.24

202.64

165 Sanctuary Wadsworth Llc 16.44 -1.79 0.00 0.00 209.19

164 Concord Care And Rehabilitation

Center

16.44 -1.79 0.00 15.73

208.63

163 Meadowbrook Manor 16.44 -1.79 0.00 13.60 221.89

162 Concord Care Center Of Cortland 16.44 -1.79 0.00 0.00

184.31

161 Concord Care Center Of Toledo 16.44 -1.79 0.00 19.13 224.10

160 Holzer Senior Care Center 16.44 -1.79 0.00 6.80

200.88

159 Arlington Pointe 16.44 -1.79 0.00 13.60 232.95

158 Parkvue Health Care Center 16.44 -1.79 0.00 10.41

Page 9: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0154459 Columbiana 3-S 117.42 56.84 9.54 1.43 2.60

0154464 Trumbull 2-L 116.59 61.15 10.17 2.16 2.08

0155262 Cuyahoga 2-S 123.56 63.85 10.79 1.96 2.08

0157513 Lawrence 3-S 105.07 56.84 9.54 1.43 1.56

0157521 Hardin 3-S 110.26 56.84 9.54 1.43 2.08

0157781 Hamilton 1-S 122.00 61.65 10.50 2.04 1.56

0158887 Lorain 2-L 125.92 61.15 10.17 1.84 1.04

0160229 Franklin 2-S 116.43 63.85 10.79 1.96 2.08

0160396 Clermont 1-S 114.48 61.65 10.50 0.00 1.04

0161766 Butler 1-S 111.42 61.65 10.50 2.82 2.08

0163033 Lawrence 3-S 109.62 56.84 9.54 1.43 1.04

0163324 Medina 2-S 121.64 63.85 10.79 1.96 1.56

0163338 Franklin 2-S 109.78 63.85 10.79 1.96 2.08

0163748 Montgomery 2-S 117.19 63.85 10.79 1.96 1.04

0163908 Washington 3-S 101.35 56.84 9.54 1.43 2.60

0164049 Lorain 2-S 114.78 63.85 10.79 2.47 1.04

0166580 Franklin 2-S 120.73 63.85 10.79 1.96 1.04

0167037 Knox 2-L 116.80 61.15 10.17 1.38 2.60

0167747 Adams 3-S 120.36 56.84 9.54 1.43 1.56

0168919 Lorain 2-L 120.85 61.15 10.17 2.16 2.08

0168954 Henry 3-S 115.05 56.84 9.54 1.43 2.60

0169879 Cuyahoga 2-L 106.86 61.15 10.17 2.16 2.08

0172790 Cuyahoga 2-S 127.61 63.85 10.79 2.13 2.08

205.57

203 Hillside Plaza 16.44 -1.79 0.00 14.66 235.77

202 Westlake Rehab And Nursing

Center

16.44 -1.79 0.00 8.50

225.30

201 Northcrest Rehab And Nursing

Center

16.44 -1.79 0.00 11.48 211.59

200 Avon Place 16.44 -1.79 0.00 14.24

206.75

199 Monarch Meadows Nursing And

Rehabilitation

16.44 -1.79 0.00 14.66 219.04

198 Country Court 16.44 -1.79 0.00 0.00

224.16

197 West Park Care Center 16.44 -1.79 0.00 12.96 225.98

196 The Villa Camillus Inc 16.44 -1.79 0.00 16.58

220.74

195 Belpre Landing Nursing &

Rehabilitation

16.44 -1.79 0.00 5.95 192.36

194 Sanctuary At Wilmington Place 16.44 -1.79 0.00 11.26

214.45

193 The Santuary At Tuttle Crossing 16.44 -1.79 0.00 9.35 212.46

192 Samaritan Care Center 16.44 -1.79 0.00 0.00

212.05

191 Sanctuary At Ohio Valley 16.44 -1.79 0.00 10.20 203.32

190 Woodland Country Manor 16.44 -1.79 0.00 8.93

222.30

189 Otterbein Loveland 16.44 -1.79 0.00 5.10 207.42

188 Meadow Grove Transitional Care 16.44 -1.79 0.00 12.54

223.88

187 Amherst Manor, Inc. 16.44 -1.79 0.00 9.56 224.33

186 Scarlet Oaks Nursing And

Rehabilitation Center Llc

16.44 -1.79 0.00 11.48

201.20

185 Vancrest Of Ada 16.44 -1.79 0.00 7.44 202.24

184 Crystal Care Of Coal Grove 16.44 -1.79 0.00 12.11

218.70

183 Seven Hills Health & Rehab Center 16.44 -1.79 0.00 13.81 230.70

182 Continuing Healthcare At The

Ridge

16.44 -1.79 0.00 11.90

181 Continuing Healthcare Of Lisbon 16.44 -1.79 0.00 8.50 210.98

Page 10: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0172923 Jackson 3-S 92.47 56.84 9.54 0.03 1.04

0172950 Wood 2-S 107.94 63.85 10.79 0.00 1.04

0175153 Cuyahoga 2-L 122.25 61.15 10.17 5.34 2.08

0178127 Lake 2-S 112.78 63.85 10.79 1.96 1.56

0180181 Vinton 3-S 82.23 56.84 9.54 1.43 1.04

0180576 Portage 2-S 112.17 63.85 10.79 3.67 2.60

0180594 Holmes 3-L 97.66 57.68 7.99 2.19 2.60

0184947 Jefferson 3-S 107.57 56.84 9.54 2.02 2.08

0187757 Scioto 3-L 107.05 57.68 7.99 1.52 1.56

0187906 Stark 2-S 110.12 63.85 10.79 1.96 2.08

0190776 Trumbull 2-S 93.24 63.85 10.79 1.96 2.08

0190993 Tuscarawas 3-S 97.57 56.84 9.54 1.43 3.12

0192560 Butler 1-S 100.40 61.65 10.50 0.00 1.56

0194196 Warren 1-S 90.36 61.65 10.50 0.00 2.08

0195314 Knox 2-S 190.54 63.85 10.79 1.96 2.08

0195461 Logan 3-S 98.65 56.84 9.54 1.43 2.08

0195706 Champaign 2-S 115.07 63.85 10.79 1.96 1.56

0196685 Fairfield 2-S 111.95 63.85 10.79 3.23 3.12

0198307 Hancock 2-S 90.80 63.85 10.79 0.09 2.60

0198312 Lucas 2-S 108.06 63.85 10.79 1.96 1.04

0198857 Sandusky 2-S 112.71 63.85 10.79 1.96 2.08

0201077 Belmont 3-S 122.13 56.84 9.54 1.43 2.08

0201104 Hamilton 1-L 122.15 58.99 11.11 2.38 1.04 226.26226 Mt. Airy Gardens Rehabilitation

And Nursing Center

16.44 -1.79 0.00 15.94

219.64

225 Rolling Hills Rehabilitation And

Care Center Llc

16.44 -1.79 0.00 0.00 206.67

224 Valley View Health Campus 16.44 -1.79 0.00 13.60

194.68

223 The Lakes Of Sylvania 16.44 -1.79 0.00 0.00 200.35

222 Good Samaritan Society-Arlington 16.44 -1.79 0.00 11.90

212.98

221 Main Street Terrace Care Center 16.44 -1.79 0.00 14.88 222.47

220 Urbana Health & Rehab Center 16.44 -1.79 0.00 5.10

285.57

219 Indian Lake Rehabilitation Center 16.44 -1.79 0.00 8.29 191.48

218 Centerburg Respiratory And

Specialty Rehab Center

16.44 -1.79 0.00 1.70

188.76

217 Quaker Heights Care Community 16.44 -1.79 0.00 12.54 191.78

216 Jamestowne Rehabilitation 16.44 -1.79 0.00 0.00

196.35

215 Park Village Hc Np Llc 16.44 -1.79 0.00 9.14 192.29

214 White Oak Manor 16.44 -1.79 0.00 9.78

190.45

213 Sprenger Health Care Of Massillon

Snf Inc

16.44 -1.79 0.00 15.94 219.39

212 Dba Best Care Nursing And

Rehabilitation Center

16.44 -1.79 0.00 0.00

199.77

211 Lancia Villa Royale 16.44 -1.79 0.00 11.90 204.60

210 Sycamore Run Nursing &

Rehabilitation Center

16.44 -1.79 0.00 17.00

165.73

209 Kensington At Anna Maria 16.44 -1.79 0.00 11.26 218.99

208 Hamden Health Care Ventures, Inc. 16.44 -1.79 0.00 0.00

230.30

207 Concord Village Skilled Nursing &

Rehabilitation

16.44 -1.79 0.00 11.26 216.85

206 Cedarwood Plaza 16.44 -1.79 0.00 14.66

183.71

205 Wood Haven Health Care Senior

Living And Rehabilitation

16.44 -1.79 0.00 0.00 198.27

204 Jenkins Care Community 16.44 -1.79 0.00 9.14

Page 11: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0201401 Cuyahoga 2-L 115.51 61.15 10.17 2.16 1.04

0201868 Franklin 2-L 131.53 61.15 10.17 2.16 2.60

0201870 Union 2-S 117.94 63.85 10.79 1.96 2.60

0201877 Fairfield 2-S 120.97 63.85 10.79 1.96 1.04

0201879 Preble 2-S 121.26 63.85 10.79 1.96 2.60

0204489 Lucas 2-L 102.69 61.15 10.17 2.16 2.60

0204960 Franklin 2-S 106.99 63.85 10.79 0.00 1.56

0208120 Allen 2-L 140.99 61.15 10.17 2.16 2.08

0209932 Mahoning 2-S 109.38 63.85 10.79 0.00 3.12

0209934 Brown 1-L 129.77 58.99 11.11 2.38 1.56

0213298 Hamilton 1-S 113.36 61.65 10.50 2.04 2.08

0213983 Lake 2-L 119.56 61.15 10.17 2.16 2.08

0214397 Mahoning 2-L 101.80 61.15 10.17 0.22 1.56

0214921 Ashtabula 2-S 121.37 63.85 10.79 1.96 1.56

0215086 Ashtabula 2-S 128.41 63.85 10.79 1.96 1.56

0219838 Cuyahoga 2-S 108.98 63.85 10.79 0.00 2.08

0226376 Lake 2-S 113.29 63.85 10.79 1.96 1.04

0228088 Auglaize 3-S 109.04 56.84 9.54 0.00 1.56

0228463 Summit 2-S 120.73 63.85 10.79 1.96 1.04

0228640 Allen 2-S 97.29 63.85 10.79 0.00 2.08

0229882 Lawrence 3-L 121.77 57.68 7.99 1.43 2.08

0234428 Hamilton 1-L 116.34 58.99 11.11 1.61 3.64

0234459 Union 2-S 104.23 63.85 10.79 1.96 0.52

0234954 Knox 2-S 111.09 63.85 10.79 1.96 3.12 211.41250 Mount Vernon Health And

Rehabilitation Center

16.44 -1.79 0.00 5.95

223.98

249 Milcrest Nursing Center 16.44 -1.79 0.00 7.01 203.01

248 Clifton Care Center, Inc. 16.44 -1.79 0.00 17.64

195.89

247 Harbor Healthcare Of Ironton 16.44 -1.79 0.00 11.69 217.29

246 Mennonite Memorial Home 16.44 -1.79 0.00 7.23

204.59

245 Avenue At Macedonia 16.44 -1.79 0.00 0.00 213.02

244 Otterbein-Cridersville 16.44 -1.79 0.00 12.96

215.86

243 Mentor Ridge Health And

Rehabilitation

16.44 -1.79 0.00 15.30 220.88

242 Welsh Home (The) 16.44 -1.79 0.00 15.51

222.47

241 Lake Pointe Rehabilitation &

Nursing Center

16.44 -1.79 0.00 0.00 221.22

240 Eagle Pointe Skilled Nursing &

Rehab

16.44 -1.79 0.00 8.29

221.88

239 Assumption Village (The) 16.44 -1.79 0.00 8.29 197.84

238 Cardinal Woods Skilled Nursing &

Rehab Center

16.44 -1.79 0.00 12.11

233.12

237 Blue Ash Care Center 16.44 -1.79 0.00 12.75 217.03

236 Ohio Valley Manor Nursing And

Rehabilitation

16.44 -1.79 0.00 14.66

231.20

235 Shepherd Of The Valley Poland 16.44 -1.79 0.00 15.73 217.52

234 Liberty Retirement Community Of

Lima Inc

16.44 -1.79 0.00 0.00

205.11

233 Wesley Glen 16.44 -1.79 0.00 0.00 197.84

232 Spring Meadow Nursing &

Rehabilitation Centre, Llc

16.44 -1.79 0.00 11.69

213.26

231 Maple Gardens Rehabilitation And

Nursing Center

16.44 -1.79 0.00 14.24 229.35

230 Country Lane Gardens

Rehabilitation And Nursing Center

16.44 -1.79 0.00 0.00

236.50

229 Prestige Gardens Rehabilitation

And Nursing Center

16.44 -1.79 0.00 0.00 211.79

228 Capital City Gardens Rehabilitation

And Nursing Center

16.44 -1.79 0.00 14.24

227 Rocky River Gardens

Rehabilitation And Nursing Center

16.44 -1.79 0.00 14.88 219.56

Page 12: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0235466 Stark 2-L 109.88 61.15 10.17 2.16 2.08

0235701 Summit 2-L 113.03 61.15 10.17 2.16 2.60

0235751 Franklin 2-S 115.96 63.85 10.79 1.96 1.56

0235771 Ross 2-L 115.16 61.15 10.17 2.16 1.56

0235952 Hamilton 1-L 95.03 58.99 11.11 2.38 1.56

0236872 Cuyahoga 2-S 121.84 63.85 10.79 1.96 1.56

0237836 Ashtabula 2-L 116.74 61.15 10.17 0.00 1.56

0241166 Cuyahoga 2-S 119.22 63.85 10.79 1.96 1.56

0243735 Richland 3-S 125.49 56.84 9.54 1.43 2.60

0243831 Stark 2-S 123.73 63.85 10.79 1.96 1.56

0243837 Crawford 3-S 117.77 56.84 9.54 1.43 1.04

0243851 Cuyahoga 2-S 117.12 63.85 10.79 1.96 1.04

0243863 Summit 2-S 118.01 63.85 10.79 1.96 1.04

0243899 Franklin 2-S 122.64 63.85 10.79 1.96 1.56

0243951 Knox 2-S 125.73 63.85 10.79 1.96 0.52

0244304 Lucas 2-S 110.61 63.85 10.79 1.96 1.04

0245052 Cuyahoga 2-L 115.52 61.15 10.17 2.16 0.52

0245084 Licking 2-L 115.82 61.15 10.17 2.16 1.04

0245097 Cuyahoga 2-L 107.54 61.15 10.17 2.16 0.52

0245111 Marion 2-S 120.33 63.85 10.79 1.96 2.08

0245119 Lake 2-S 108.18 63.85 10.79 1.96 1.04

0245436 Highland 3-S 112.64 56.84 9.54 1.43 2.08

0245442 Hardin 3-L 107.35 57.68 7.99 1.43 1.04

207.59

273 Kenton Nursing & Rehabilitation

Center

16.44 -1.79 0.00 0.00 190.14

272 Edgewood Manor Of Greenfield 16.44 -1.79 0.00 10.41

225.56

271 Lakemed Care And Rehabilitation 16.44 -1.79 0.00 9.56 210.03

270 Community Care And

Rehabilitation

16.44 -1.79 0.00 11.90

219.02

269 Stratford Care And Rehabilitation 16.44 -1.79 0.00 0.00 196.19

268 Newark Care And Rehabilitation 16.44 -1.79 0.00 14.03

202.90

267 The Greens Care And

Rehabilitation

16.44 -1.79 0.00 0.00 204.17

266 Addison Heights Health And

Rehabilitation Center

16.44 -1.79 0.00 0.00

223.10

265 Whispering Hills Rehabilitation

And Nursing Center

16.44 -1.79 0.00 4.89 222.39

264 Buckeye Terrace Rehabilitation

And Nursing Center

16.44 -1.79 0.00 7.65

209.41

263 The Pinnacle Rehabilitation And

Nursing Center

16.44 -1.79 0.00 11.90 222.20

262 The Pavilion Rehabilitation And

Nursing Center

16.44 -1.79 0.00 0.00

231.20

261 Crestline Rehabilitation And

Nursing Center

16.44 -1.79 0.00 10.41 211.68

260 Legends Care Rehabilitation And

Nursing Center

16.44 -1.79 0.00 14.66

223.08

259 Country Meadow Rehabilitation

And Nursing Center

16.44 -1.79 0.00 13.60 224.15

258 Landerbrook Transitional Care 16.44 -1.79 0.00 11.05

214.65

257 Ashtabula County Nursing Home 16.44 -1.79 0.00 13.39 217.66

256 The Laurels Of Chagrin Falls 16.44 -1.79 0.00 0.00

213.35

255 Montgomery Care Center 16.44 -1.79 0.00 12.75 196.47

254 Westmoreland Place 16.44 -1.79 0.00 8.50

213.11

253 Continuing Healthcare Of Gahanna 16.44 -1.79 0.00 11.05 219.82

252 Continuing Healthcare Of

Cuyahoga Falls

16.44 -1.79 0.00 9.35

251 Glenwood Care And Rehabilitation 16.44 -1.79 0.00 0.00 200.09

Page 13: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0245564 Scioto 3-S 100.87 56.84 9.54 1.43 2.60

0245565 Medina 2-S 114.65 63.85 10.79 1.96 1.04

0245568 Scioto 3-S 109.15 56.84 9.54 1.43 1.04

0245571 Sandusky 2-S 122.50 63.85 10.79 1.96 1.56

0245823 Pike 3-S 97.93 56.84 9.54 1.43 2.08

0246036 Lucas 2-S 108.50 63.85 10.79 1.96 1.04

0246372 Jackson 3-S 111.04 56.84 9.54 1.43 1.56

0248212 Lake 2-S 117.55 63.85 10.79 1.96 2.08

0249193 Cuyahoga 2-S 102.07 63.85 10.79 1.96 1.04

0250097 Mahoning 2-S 104.97 63.85 10.79 1.96 1.04

0257028 Franklin 2-S 121.52 63.85 10.79 1.96 1.04

0257029 Lucas 2-L 127.24 61.15 10.17 3.49 2.60

0257045 Hamilton 1-L 122.97 58.99 11.11 2.38 1.56

0257117 Clark 2-S 112.20 63.85 10.79 1.96 1.56

0257125 Lucas 2-S 99.24 63.85 10.79 1.96 1.56

0257180 Hamilton 1-S 121.06 61.65 10.50 2.04 2.60

0258073 Williams 3-S 98.12 56.84 9.54 0.00 3.64

0259829 Allen 2-S 120.76 63.85 10.79 1.96 1.56

0259856 Jefferson 3-S 99.06 56.84 9.54 1.43 2.08

0259883 Licking 2-S 116.53 63.85 10.79 1.96 1.56

0259960 Licking 2-S 105.24 63.85 10.79 1.96 2.08

0259968 Perry 3-S 102.13 56.84 9.54 1.43 1.56

0259975 Perry 3-S 103.93 56.84 9.54 1.43 3.12 199.50296 Altercare Thornville, Inc. 16.44 -1.79 0.00 9.99

206.43

295 Altercare Somerset, Inc. 16.44 -1.79 0.00 0.00 186.15

294 Altercare Newark North, Inc. 16.44 -1.79 0.00 7.86

183.60

293 Altercare Newark South, Inc. 16.44 -1.79 0.00 0.00 209.34

292 Altercare Adena, Inc. 16.44 -1.79 0.00 0.00

198.30

291 The Meadows Of Delphos 16.44 -1.79 0.00 0.00 213.57

290 Williams County Hillside Country

Living

16.44 -1.79 0.00 15.51

205.01

289 Woods Edge Rehab And Nursing 16.44 -1.79 9.76 14.88 237.14

288 Whitehouse Country Manor 16.44 -1.79 0.00 12.96

223.14

287 Wooded Glen 16.44 -1.79 0.00 0.00 205.01

286 Harmony Court Rehab And

Nursing

16.44 -1.79 0.00 11.48

224.44

285 Orchard Villa 16.44 -1.79 0.00 0.00 219.30

284 Canal Winchester Care Center 16.44 -1.79 0.00 10.63

194.36

283 Windsor House At Canfield 16.44 -1.79 0.00 4.25 201.51

282 Rocky River Health Care Of West

Park

16.44 -1.79 0.00 0.00

207.81

281 Grand River Health & Rehab

Center

16.44 -1.79 0.00 11.26 222.14

280 Edgewood Manor Of Wellston 16.44 -1.79 0.00 12.75

190.97

279 Ridgewood Manor 16.44 -1.79 0.00 12.75 213.54

278 Piketon Nursing Center 16.44 -1.79 0.00 8.50

206.46

277 Parkview Care Center 16.44 -1.79 0.00 0.00 215.31

276 Edgewood Manor Of Lucasville I 16.44 -1.79 0.00 13.81

201.02

275 Brunswick Pointe Transitional Care 16.44 -1.79 0.00 13.39 220.33

274 Edgewood Manor Of Lucasville Ii 16.44 -1.79 0.00 15.09

Page 14: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0259993 Muskingum 3-S 102.57 56.84 9.54 1.43 1.56

0262067 Trumbull 2-S 135.31 63.85 10.79 1.96 3.12

0262114 Hamilton 1-S 109.77 61.65 10.50 2.04 2.08

0262293 Stark 2-S 127.08 63.85 10.79 1.96 2.60

0262323 Summit 2-L 116.76 61.15 10.17 2.16 1.56

0262401 Auglaize 3-S 109.73 56.84 9.54 1.43 2.08

0262446 Columbiana 3-S 119.56 56.84 9.54 1.43 1.04

0262661 Williams 3-S 113.58 56.84 9.54 1.43 2.08

0262714 Jefferson 3-S 105.90 56.84 9.54 1.43 1.04

0262762 Mahoning 2-S 123.56 63.85 10.79 1.96 2.08

0263087 Mahoning 2-S 130.43 63.85 10.79 1.96 1.56

0263159 Columbiana 3-S 110.70 56.84 9.54 1.43 2.08

0263279 Wayne 3-S 110.71 56.84 9.54 1.43 2.08

0265424 Auglaize 3-S 108.41 56.84 9.54 1.43 2.60

0265425 Greene 2-S 114.75 63.85 10.79 1.96 1.56

0265426 Greene 2-S 110.48 63.85 10.79 1.96 2.08

0270111 Shelby 3-L 85.97 57.68 7.99 0.00 1.56

0272990 Cuyahoga 2-L 122.58 61.15 10.17 2.16 2.60

0273052 Portage 2-S 116.36 63.85 10.79 1.96 3.12

0273070 Cuyahoga 2-L 110.54 61.15 10.17 2.16 2.60

0273085 Cuyahoga 2-L 119.10 61.15 10.17 2.16 2.08

0273090 Cuyahoga 2-L 110.45 61.15 10.17 2.16 1.56

0274804 Knox 2-S 98.94 63.85 10.79 0.00 1.04

223.37

319 Ohio Eastern Star Health Care

Center (The)

16.44 -1.79 0.00 9.14 198.41

318 Cityview Healthcare And

Rehabilitation

16.44 -1.79 9.20 14.03

214.23

317 Suburban Healthcare And

Rehabilitation

16.44 -1.79 0.00 15.09 224.40

316 Candlewood Healthcare And

Rehabilitation

16.44 -1.79 0.00 12.96

225.21

315 Kent Healthcare And Rehabilitation 16.44 -1.79 0.00 17.21 227.94

314 Aristocrat Berea Healthcare And

Rehabilitation

16.44 -1.79 0.00 11.90

203.81

313 Fair Haven/Shelby County Home 16.44 -1.79 0.00 14.66 182.51

312 Hospitality Healthcare Llc 16.44 -1.79 0.00 0.00

207.07

311 Harmony Center For Rehabilitation

And Healing

16.44 -1.79 0.00 0.00 207.56

310 Heritage Center For Rehabilitation

And Specialty

16.44 -1.79 0.00 13.60

208.20

309 Avenue At Wooster 16.44 -1.79 0.00 9.56 204.81

308 Salem West Healthcare Center 16.44 -1.79 0.00 12.96

232.19

307 Canfield Healthcare Center 16.44 -1.79 0.00 17.21 240.45

306 Austintown Healthcare Center 16.44 -1.79 0.00 15.30

212.78

305 Dixon Healthcare Center 16.44 -1.79 0.00 13.81 203.21

304 Evergreen Healthcare Center 16.44 -1.79 0.00 14.66

194.27

303 Salem North Healthcare Center 16.44 -1.79 0.00 0.00 203.06

302 Grande Lake Healthcare Center 16.44 -1.79 0.00 0.00

232.41

301 The Colony Healthcare Center 16.44 -1.79 0.00 15.51 221.96

300 The Pines Healthcare Center 16.44 -1.79 0.00 11.48

244.34

299 Wexford Care Center 16.44 -1.79 0.00 17.21 217.90

298 Addison Healthcare Center 16.44 -1.79 0.00 14.66

297 Altercare Zanesville, Inc 16.44 -1.79 0.00 0.00 186.59

Page 15: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0277382 Hamilton 1-L 105.62 58.99 11.11 2.38 1.56

0277592 Paulding 3-S 106.04 56.84 9.54 1.43 2.60

0278542 Cuyahoga 2-L 107.78 61.15 10.17 0.00 2.60

0279832 Cuyahoga 2-S 111.94 63.85 10.79 1.96 2.08

0283333 Lucas 2-L 96.86 61.15 10.17 2.16 1.56

0283378 Huron 3-S 96.75 56.84 9.54 1.43 2.08

0283787 Stark 2-L 112.10 61.15 10.17 2.46 2.08

0283946 Greene 2-S 109.25 63.85 10.79 1.96 0.52

0284228 Montgomery 2-L 113.00 61.15 10.17 2.16 1.04

0284367 Greene 2-S 112.19 63.85 10.79 1.96 2.08

0285530 Clermont 1-S 122.21 61.65 10.50 2.04 0.52

0285999 Hamilton 1-S 122.61 61.65 10.50 2.04 1.04

0286012 Greene 2-S 166.62 63.85 10.79 1.96 1.04

0287326 Allen 2-S 112.43 63.85 10.79 1.96 1.56

0287576 Montgomery 2-L 104.34 61.15 10.17 2.16 1.56

0287598 Warren 1-L 111.15 58.99 11.11 2.38 1.56

0288016 Scioto 3-S 111.28 56.84 9.54 1.43 1.56

0288043 Greene 2-S 110.98 63.85 10.79 1.96 1.04

0288489 Ashtabula 2-L 123.88 61.15 10.17 2.16 3.12

0289153 Pike 3-L 121.59 57.68 7.99 1.43 1.04

0289551 Summit 2-L 98.70 61.15 10.17 2.16 3.12

0289749 Holmes 3-S 94.13 56.84 9.54 1.43 2.60

0289982 Ashtabula 2-S 124.38 63.85 10.79 1.96 1.56 231.22342 Pine Grove Healthcare Center 16.44 -1.79 0.00 14.03

203.55

341 Oakpointe Nursing &

Rehabilitation

16.44 -1.79 0.00 17.21 196.40

340 Hickory Ridge Nursing &

Rehabilitation Center

16.44 -1.79 0.00 13.60

232.77

339 The Pavilion At Piketon 16.44 -1.79 0.00 0.00 204.38

338 Carington Park 16.44 -1.79 0.00 17.64

201.04

337 Xenia Health And Rehab 16.44 -1.79 0.00 14.03 217.30

336 Portsmouth Health And Rehab 16.44 -1.79 0.00 5.74

194.03

335 Cedar Village Senior Living 16.44 -1.79 0.00 11.48 211.32

334 Centerville Health And Rehab 16.44 -1.79 0.00 0.00

258.91

333 The Springs Of Lima 16.44 -1.79 0.00 7.23 212.47

332 Bellbrook Health And Rehab 16.44 -1.79 0.00 0.00

211.57

331 Fountains Transitional Care Center 16.44 -1.79 0.00 0.00 212.49

330 The Glen 16.44 -1.79 0.00 0.00

202.17

329 Jamestown Place Health And

Rehab

16.44 -1.79 0.00 0.00 205.52

328 Englewood Health And Rehab 16.44 -1.79 0.00 0.00

212.60

327 Beavercreek Health And Rehab 16.44 -1.79 0.00 0.00 201.02

326 Laurels Of Massillon (The) 16.44 -1.79 0.00 9.99

200.79

325 Willard Healthcare 16.44 -1.79 0.00 14.66 195.95

324 Toledo Healthcare 16.44 -1.79 0.00 14.24

208.04

323 Shaker Gardens Nursing And

Rehabilitation Center

16.44 -1.79 0.00 11.90 217.17

322 Eliza Jennings Home (The) 16.44 -1.79 0.00 11.69

208.97

321 Vancrest Of Payne 16.44 -1.79 0.00 9.35 200.45

320 Wexford Place 16.44 -1.79 0.00 14.66

Page 16: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0289997 Cuyahoga 2-S 94.59 63.85 10.79 1.96 2.60

0291303 Holmes 3-L 93.56 57.68 7.99 0.99 2.60

0292159 Guernsey 3-S 105.09 56.84 9.54 1.43 1.04

0292321 Coshocton 3-S 103.33 56.84 9.54 1.43 2.08

0292331 Franklin 2-L 113.71 61.15 10.17 2.16 1.04

0292352 Butler 1-L 114.77 58.99 11.11 2.38 1.04

0292821 Butler 1-S 108.62 61.65 10.50 2.04 0.52

0292917 Clermont 1-L 113.50 58.99 11.11 2.38 1.56

0294954 Licking 2-L 125.74 61.15 10.17 2.16 1.56

0295508 Franklin 2-L 117.63 61.15 10.17 2.16 1.56

0297513 Mahoning 2-L 139.81 61.15 10.17 2.16 1.56

0297550 Mahoning 2-S 124.31 63.85 10.79 1.96 1.56

0297807 Ashland 3-S 108.26 56.84 9.54 1.75 2.60

0298083 Hamilton 1-S 94.83 61.65 10.50 2.04 0.52

0298735 Stark 2-S 113.14 63.85 10.79 0.00 2.60

0298958 Hamilton 1-S 113.68 61.65 10.50 2.04 1.56

0301054 Summit 2-S 82.88 63.85 10.79 1.96 0.52

0301726 Summit 2-S 124.82 63.85 10.79 1.96 2.08

0303083 Clermont 1-S 115.61 61.65 10.50 2.04 1.56

0303741 Cuyahoga 2-S 111.36 63.85 10.79 1.96 0.52

0306768 Hamilton 1-S 104.77 61.65 10.50 2.04 1.56

0307140 Hamilton 1-S 113.05 61.65 10.50 2.04 2.08

0307318 Sandusky 2-S 118.96 63.85 10.79 1.96 1.56

217.36

365 Countryside Manor Nursing &

Rehabilitation Center

16.44 -1.79 0.00 6.80 218.57

364 Carecore At The Meadows 16.44 -1.79 0.00 13.39

216.31

363 Garden Park Health Care Center 16.44 -1.79 8.95 9.78 213.90

362 O'Neill Healthcare North Olmsted 16.44 -1.79 0.00 13.18

218.15

361 Siena Gardens Rehabilitation &

Transitional Care

16.44 -1.79 0.00 0.00 206.01

360 Blue Stream Rehab And Nursing 16.44 -1.79 0.00 0.00

215.98

359 Regency Care Of Copley 16.44 -1.79 0.00 6.80 181.45

358 Astoria Place Of Silverton Llc 16.44 -1.79 0.00 11.90

203.27

357 Saint Joseph Care Center 16.44 -1.79 0.00 6.38 211.41

356 Astoria Place Of Cincinnati Llc 16.44 -1.79 8.45 10.63

235.40

355 Colonial Manor Health Care

Center, Inc.

16.44 -1.79 0.00 10.41 204.05

354 Oasis Center For Rehabilitation

And Healing

16.44 -1.79 0.00 18.28

220.28

353 Beeghly Oaks Center For

Rehabilitation And Healing

16.44 -1.79 0.00 0.00 229.50

352 The Laurels Of Walden Park 16.44 -1.79 0.00 12.96

215.37

351 The Laurels Of Heath 16.44 -1.79 0.00 7.23 222.66

350 The Laurels Of Milford 16.44 -1.79 0.00 13.18

209.74

349 The Laurels Of Hamilton 16.44 -1.79 0.00 15.51 213.49

348 The Laurels Of Middletown 16.44 -1.79 0.00 6.80

201.26

347 The Laurels Of Gahanna 16.44 -1.79 0.00 4.46 207.34

346 Altercare Coshocton, Inc. 16.44 -1.79 0.00 13.39

196.60

345 Altercare Cambridge, Inc. 16.44 -1.79 0.00 0.00 188.59

344 Scenic Pointe Nursing And

Rehabilitation Center

16.44 -1.79 0.00 19.13

343 North Park Care Center 16.44 -1.79 0.00 9.56 198.00

Page 17: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0313363 Montgomery 2-L 108.70 61.15 10.17 2.16 2.08

0315243 Darke 2-L 120.13 61.15 10.17 2.16 1.56

0315261 Clark 2-L 117.89 61.15 10.17 2.16 1.56

0316293 Lucas 2-S 120.19 63.85 10.79 1.96 3.12

0316563 Wayne 3-S 93.24 56.84 9.54 0.00 3.12

0316715 Brown 1-L 140.53 58.99 11.11 2.38 1.56

0316720 Greene 2-S 118.83 63.85 10.79 1.96 1.56

0316721 Ottawa 2-S 119.69 63.85 10.79 1.96 2.08

0318435 Hamilton 1-L 134.03 58.99 11.11 2.38 2.08

0318856 Erie 3-L 109.10 57.68 7.99 0.00 2.60

0320499 Huron 3-L 108.84 57.68 7.99 1.43 0.52

0321655 Stark 2-S 105.12 63.85 10.79 3.31 2.08

0321664 Geauga 2-S 122.45 63.85 10.79 2.54 2.60

0321691 Butler 1-L 105.35 58.99 11.11 0.00 2.60

0323733 Lorain 2-S 117.39 63.85 10.79 2.73 2.08

0324096 Montgomery 2-L 100.98 61.15 10.17 2.16 2.60

0325624 Wyandot 3-S 103.89 56.84 9.54 0.00 1.56

0325709 Lucas 2-S 131.23 63.85 10.79 1.96 1.04

0325832 Summit 2-S 126.43 63.85 10.79 1.96 1.56

0325992 Shelby 3-S 90.76 56.84 9.54 1.43 2.60

0326066 Hamilton 1-S 113.36 61.65 10.50 2.04 1.56

0326090 Butler 1-S 108.08 61.65 10.50 2.04 1.04

0326201 Champaign 2-S 85.36 63.85 10.79 1.96 2.08 196.33388 Spring Meadows 16.44 -1.79 0.00 17.64

222.04

387 Glen Meadows 16.44 -1.79 0.00 12.33 210.29

386 Residence At Salem Woods 16.44 -1.79 0.00 18.28

228.59

385 Sidney Care Center 16.44 -1.79 0.00 17.00 192.82

384 Canterbury Of Twinsburg 16.44 -1.79 0.00 9.35

186.48

383 Advanced Healthcare Center 16.44 -1.79 0.00 13.18 236.70

382 Wyandot County Skilled Nursing

And Rehabilitation Center

16.44 -1.79 0.00 0.00

224.67

381 Crossroads Rehabilitation &

Nursing

16.44 -1.79 0.00 17.00 208.71

380 Autumn Aegis Nursing Home 16.44 -1.79 0.00 13.18

230.48

379 Butler County Care Facility 16.44 -1.79 0.00 0.00 192.70

378 Ohman Family Living At Blossom 16.44 -1.79 0.00 13.60

205.14

377 Brewster Parke, Inc. 16.44 -1.79 0.00 7.65 207.45

376 Gaymont Care And Rehabilitation 16.44 -1.79 0.00 14.03

231.53

375 Meadows At Osborn Park (The) 16.44 -1.79 0.00 12.75 204.77

374 Clovernook Healthcare And

Rehabilitation Center

16.44 -1.79 0.00 8.29

226.52

373 Edgewood Manor Rehabilitation 16.44 -1.79 0.00 16.15 229.17

372 Wright Rehabilitation And

Helthcare Center

16.44 -1.79 0.00 14.88

192.48

371 Villa Georgetown Rehabilitation

And Healthcare Center

16.44 -1.79 0.00 12.33 241.55

370 Apostolic Christian Home, Inc. 16.44 -1.79 0.00 15.09

222.24

369 Continuing Healthcare Of Toledo 16.44 -1.79 0.00 11.90 226.46

368 Villa Springfield 16.44 -1.79 0.00 14.66

212.51

367 Versailles Rehabilitation And

Healthcare Center

16.44 -1.79 0.00 13.81 223.63

366 Social Row Transitional Care 16.44 -1.79 0.00 13.60

Page 18: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0326880 Miami 2-S 116.18 63.85 10.79 1.96 1.04

0326897 Highland 3-S 110.27 56.84 9.54 1.43 3.12

0326928 Clark 2-S 135.42 63.85 10.79 1.96 1.56

0326934 Shelby 3-S 126.03 56.84 9.54 1.43 2.08

0327591 Clermont 1-S 118.84 61.65 10.50 2.04 1.56

0327603 Brown 1-S 104.95 61.65 10.50 2.04 1.56

0328496 Auglaize 3-S 106.09 56.84 9.54 1.43 2.08

0329164 Summit 2-L 118.31 61.15 10.17 2.16 1.56

0329165 Stark 2-L 112.45 61.15 10.17 2.16 1.04

0329167 Logan 3-S 107.11 56.84 9.54 1.43 1.56

0329169 Cuyahoga 2-L 110.11 61.15 10.17 2.16 1.56

0329172 Darke 2-S 118.62 63.85 10.79 1.96 0.52

0329179 Lucas 2-L 121.98 61.15 10.17 2.16 1.04

0329233 Jackson 3-S 114.10 56.84 9.54 1.43 1.56

0329242 Hamilton 1-L 113.55 58.99 11.11 2.38 2.60

0329333 Cuyahoga 2-L 110.33 61.15 10.17 2.16 0.52

0329349 Cuyahoga 2-L 111.97 61.15 10.17 2.16 1.56

0329378 Lucas 2-L 118.66 61.15 10.17 2.16 1.56

0329754 Miami 2-S 116.91 63.85 10.79 1.96 1.56

0329774 Scioto 3-L 113.08 57.68 7.99 1.43 0.52

0329781 Lucas 2-L 137.14 61.15 10.17 2.16 1.04

0329809 Fulton 2-S 121.05 63.85 10.79 1.96 1.56

0329814 Butler 1-L 132.59 58.99 11.11 2.38 0.52

213.86

411 Woodridge Healthcare Llc 16.44 -1.79 0.00 0.00 220.24

410 Indian Meadows 16.44 -1.79 0.00 0.00

195.35

409 Waterville Healthcare Llc 16.44 -1.79 0.00 0.00 226.31

408 Rosemount Pavilion 16.44 -1.79 0.00 0.00

208.35

407 Piqua Health And Rehab Center 16.44 -1.79 0.00 0.00 209.72

406 Oregon Healthcare Llc 16.44 -1.79 0.00 0.00

198.98

405 Lenox Ridge Nursing And Rehab 16.44 -1.79 0.00 0.00 201.66

404 Mayfield Heights Healthcare Llc 16.44 -1.79 0.00 0.00

204.28

403 Madeira Village Nursing And

Rehab

16.44 -1.79 0.00 0.00 203.28

402 Oakwood Community Health

Center

16.44 -1.79 0.00 6.16

210.39

401 Glass City Health And Rehab 16.44 -1.79 0.00 0.00 211.15

400 Greenville Health And Rehab

Center

16.44 -1.79 0.00 0.00

191.13

399 Euclid Beach Healthcare Llc 16.44 -1.79 0.00 0.00 199.80

398 Belle Springs Nursing And Rehab 16.44 -1.79 0.00 0.00

214.80

397 Belden Village Healthcare Llc 16.44 -1.79 0.00 0.00 201.62

396 Highland Square Nursing And

Rehabilitation

16.44 -1.79 0.00 6.80

206.40

395 Auglaize Acres 16.44 -1.79 0.00 0.00 190.63

394 Locust Ridge Healthcare Llc 16.44 -1.79 0.00 11.05

210.57

393 Sunrise Nursing Healthcare Llc 16.44 -1.79 0.00 7.65 216.89

392 Pavilion Care Center 16.44 -1.79 0.00 0.00

195.85

391 Eaglewood Care Center 16.44 -1.79 0.00 0.00 228.23

390 Greenfield Snf, Inc 16.44 -1.79 0.00 0.00

389 Covington Care Center 16.44 -1.79 0.00 0.00 208.47

Page 19: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0330268 Muskingum 3-L 102.61 57.68 7.99 1.43 1.04

0330279 Muskingum 3-S 102.63 56.84 9.54 1.43 1.56

0330624 Muskingum 3-S 96.89 56.84 9.54 1.43 1.04

0330746 Belmont 3-S 101.95 56.84 9.54 1.43 2.08

0330775 Belmont 3-S 101.85 56.84 9.54 1.43 1.04

0330804 Muskingum 3-S 104.98 56.84 9.54 1.43 1.04

0331135 Fairfield 2-L 138.28 61.15 10.17 2.20 1.56

0331277 Lucas 2-S 104.48 63.85 10.79 1.96 1.91

0332672 Cuyahoga 2-S 113.99 63.85 10.79 1.96 2.08

0332680 Summit 2-S 114.78 63.85 10.79 1.96 1.56

0333751 Cuyahoga 2-L 116.12 61.15 10.17 2.16 1.91

0333756 Fulton 2-S 116.43 63.85 10.79 1.96 1.91

0333763 Miami 2-L 115.66 61.15 10.17 2.16 1.91

0334395 Cuyahoga 2-L 115.17 61.15 10.17 2.16 1.91

0335695 Lorain 2-L 113.77 61.15 10.17 3.12 2.08

0335721 Clark 2-L 122.16 61.15 10.17 2.16 2.08

0337285 Seneca 2-L 107.01 61.15 10.17 2.16 1.91

0338701 Franklin 2-S 85.03 63.85 10.79 1.96 1.91

0339735 Hamilton 1-L 91.45 58.99 11.11 0.00 2.60

0340710 Licking 2-S 119.05 63.85 10.79 1.96 1.91

0340877 Cuyahoga 2-S 108.99 63.85 10.79 1.96 1.91

0341584 Franklin 2-L 113.92 61.15 10.17 2.16 1.91

0342025 Greene 2-S 103.79 63.85 10.79 0.00 1.04 194.12434 Greenewood Manor 16.44 -1.79 0.00 0.00

202.15

433 Majestic Care Of Whitehall Llc 16.44 -1.79 0.00 0.00 203.96

432 Avenue At Broadview Heights 16.44 -1.79 0.00 0.00

187.30

431 Flint Ridge Nursing &

Rehabilitation Center

16.44 -1.79 0.00 0.00 212.21

430 Maple Knoll Village 16.44 -1.79 0.00 8.50

197.05

429 Wesley Woods At New Albany 16.44 -1.79 0.00 0.00 178.19

428 St. Francis Senior Ministries 16.44 -1.79 0.00 0.00

211.10

427 Allen View Healthcare Center 16.44 -1.79 0.00 12.11 224.48

426 Avon Oaks Nursing Home 16.44 -1.79 0.00 6.16

205.70

425 Westbrook Place Rehabilitation

And Nursing Center

16.44 -1.79 0.00 0.00 205.21

424 Troy Rehabilitation And Healthcare

Center

16.44 -1.79 0.00 0.00

206.16

423 Swanton Valley Rehabilitation And

Healthcare Center

16.44 -1.79 0.00 0.00 209.59

422 The Heights Rehabilitation And

Healthcare Center

16.44 -1.79 0.00 0.00

207.32

421 Windsong Nursing & Rehab 16.44 -1.79 0.00 11.69 219.28

420 Sunrise Pointe Nursing & Rehab 16.44 -1.79 0.00 0.00

228.01

419 The Gardens Of St. Francis 16.44 -1.79 0.00 0.00 197.64

418 Crestview Rehabilitation And

Skilled Nursing Services

16.44 -1.79 0.00 0.00

198.31

417 Continuing Healthcare At Willow

Haven

16.44 -1.79 0.00 0.00 188.48

416 Continuing Healthcare Of

Shadyside

16.44 -1.79 0.00 12.96

180.39

415 Continuing Healthcare At Forest

Hill

16.44 -1.79 0.00 13.18 199.67

414 Continuing Healthcare At Cedar

Hill

16.44 -1.79 0.00 0.00

197.09

413 Continuing Healthcare At Beckett

House

16.44 -1.79 0.00 0.00 186.65

412 Continuing Healthcare At Adams

Lane

16.44 -1.79 0.00 11.69

Page 20: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0342090 Wayne 3-S 104.57 56.84 9.54 1.43 1.91

0345237 Stark 2-S 106.19 63.85 10.79 0.00 2.60

0345979 Geauga 2-S 114.40 63.85 10.79 1.81 2.60

0346030 Mahoning 2-S 108.27 63.85 10.79 0.00 3.64

0346478 Stark 2-S 109.40 63.85 10.79 1.36 3.12

0346496 Miami 2-L 121.62 61.15 10.17 0.00 1.04

0348145 Cuyahoga 2-S 95.69 63.85 10.79 3.38 1.56

0349742 Logan 3-S 93.89 56.84 9.54 0.00 3.12

0350806 Huron 3-L 120.40 57.68 7.99 1.43 1.91

0352998 Tuscarawas 3-S 92.53 56.84 9.54 1.88 1.04

0353192 Franklin 2-L 118.01 61.15 10.17 2.16 1.91

0355553 Lucas 2-S 103.42 63.85 10.79 1.96 1.91

0356264 Allen 2-S 95.46 63.85 10.79 1.96 1.91

0357762 Hamilton 1-S 105.89 61.65 10.50 2.04 1.91

0358163 Lucas 2-S 104.06 63.85 10.79 1.96 1.91

0358343 Pickaway 2-S 112.16 63.85 10.79 1.96 1.91

0358527 Hamilton 1-S 111.20 61.65 10.50 0.00 2.60

0358530 Fairfield 2-S 126.56 63.85 10.79 1.96 1.91

0358562 Marion 2-S 125.68 63.85 10.79 1.96 1.91

0359638 Cuyahoga 2-S 100.50 63.85 10.79 1.96 1.91

0361041 Delaware 2-S 131.43 63.85 10.79 1.96 1.91

0362746 Williams 3-L 104.61 57.68 7.99 1.43 1.91 188.27456 Skld Bryan 16.44 -1.79 0.00 0.00

193.66

455 Capri Gardens 16.44 -1.79 0.00 0.00 224.59

454 Regency Care Of Larchwood 16.44 -1.79 0.00 0.00

219.72

453 Presidential Post Acute 16.44 -1.79 0.00 0.00 218.84

452 Buckeye Care And Rehabilitation 16.44 -1.79 0.00 0.00

205.32

451 Archbishop Leibold Home For The

Aged

16.44 -1.79 0.00 10.84 211.44

450 Circleville Post Acute 16.44 -1.79 0.00 0.00

196.64

449 Divine Rehabilitation And Nursing

At Sylvania

16.44 -1.79 0.00 0.00 197.22

448 Bridgetown Nursing &

Rehabilitation Centre

16.44 -1.79 0.00 0.00

196.58

447 Carecore At Lima, Llc 16.44 -1.79 0.00 0.00 188.62

446 Promedica Goerlich Memory Care

Center (Syvania)

16.44 -1.79 0.00 0.00

184.98

445 Majestic Care Of Columbus Llc 16.44 -1.79 0.00 0.00 208.05

444 Park Village Health Care Center 16.44 -1.79 0.00 8.50

191.64

443 Twilight Gardens Nursing &

Rehabilitation

16.44 -1.79 0.00 0.00 204.06

442 Green Hills Center 16.44 -1.79 0.00 13.60

223.72

441 Rae-Ann Suburban 16.44 -1.79 0.00 11.69 201.61

440 Koester Pavilion 16.44 -1.79 0.00 15.09

201.20

439 Country Lawn Center For

Rehabilitation And Nursing Care,

Inc.

16.44 -1.79 0.00 14.66 217.83

438 Shepherd Of The Valley-Boardman 16.44 -1.79 0.00 0.00

204.88

437 Burton Health Care Center 16.44 -1.79 0.00 13.18 221.28

436 Canton Christian Home, Inc. 16.44 -1.79 0.00 6.80

435 Accord Care Community-Orrville 16.44 -1.79 0.00 0.00 188.94

Page 21: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0362787 Defiance 3-S 108.73 56.84 9.54 1.43 1.91

0362812 Montgomery 2-L 112.66 61.15 10.17 2.16 1.91

0362824 Perry 3-L 110.23 57.68 7.99 1.43 1.91

0362831 Lucas 2-S 105.22 63.85 10.79 1.96 1.91

0362836 Wood 2-S 124.37 63.85 10.79 1.96 1.91

0363613 Auglaize 3-S 101.01 56.84 9.54 1.43 1.91

0364369 Cuyahoga 2-S 93.83 63.85 10.79 5.78 2.08

0367697 Tuscarawas 3-S 93.31 56.84 9.54 1.93 2.60

0371963 Butler 1-L 125.18 58.99 11.11 2.38 1.91

0371987 Hamilton 1-L 123.73 58.99 11.11 2.38 1.91

0372003 Hamilton 1-S 121.48 61.65 10.50 2.04 1.91

0372009 Hamilton 1-S 115.92 61.65 10.50 2.04 1.91

0372087 Butler 1-S 132.62 61.65 10.50 2.04 1.91

0372168 Hamilton 1-S 123.39 61.65 10.50 2.04 1.91

0372176 Hamilton 1-L 144.99 58.99 11.11 2.38 1.91

0372311 Hamilton 1-L 125.81 58.99 11.11 2.38 1.91

0373459 Fairfield 2-S 118.39 63.85 10.79 1.96 1.91

0374161 Cuyahoga 2-L 118.05 61.15 10.17 3.16 3.12

0374303 Franklin 2-S 102.50 63.85 10.79 2.38 2.08

0374413 Hamilton 1-L 105.04 58.99 11.11 2.38 1.91

0375202 Seneca 2-S 110.98 63.85 10.79 1.96 1.91

0375964 Cuyahoga 2-S 121.28 63.85 10.79 4.52 1.56

0376649 Franklin 2-S 117.30 63.85 10.79 1.96 1.91

230.89

479 Smith'S Mill Health Campus 16.44 -1.79 0.00 0.00 210.46

478 Enniscourt Nursing Care 16.44 -1.79 0.00 14.24

194.08

477 The Willows At Tiffin 16.44 -1.79 0.00 0.00 204.14

476 The Chateau At Mountain Crest

Nursing & Rehab

16.44 -1.79 0.00 0.00

225.39

475 Scioto Pointe 16.44 -1.79 0.00 18.28 214.53

474 Franklin Plaza Extended Care 16.44 -1.79 0.00 15.09

214.85

473 Violet Springs Health Campus 16.44 -1.79 0.00 0.00 211.55

472 Burlington House Rehab &

Alzheimer'S Care Center

16.44 -1.79 0.00 0.00

214.14

471 Three Rivers Healthcare Center 16.44 -1.79 0.00 0.00 234.03

470 Brookside Healthcare Center 16.44 -1.79 0.00 0.00

206.67

469 Oxford Healthcare Center 16.44 -1.79 0.00 0.00 223.37

468 Highlands Post Acute 16.44 -1.79 0.00 0.00

212.77

467 Norwood Towers Post Acute 16.44 -1.79 0.00 0.00 212.23

466 Delhi Post Acute 16.44 -1.79 0.00 0.00

188.43

465 Willow Knoll Post Acute And

Senior Living

16.44 -1.79 0.00 0.00 214.22

464 Riverside Manor Nursing And Care

Center

16.44 -1.79 0.00 9.56

185.38

463 Fairfax Health Care Center 16.44 -1.79 0.00 0.00 190.98

462 Vancrest Of St. Marys 16.44 -1.79 0.00 0.00

198.38

461 Skld Perrysburf 16.44 -1.79 0.00 0.00 217.53

460 Skld Point Place 16.44 -1.79 0.00 0.00

202.70

459 Skld New Lexington 16.44 -1.79 0.00 0.00 193.89

458 Skld New Lebanon 16.44 -1.79 0.00 0.00

457 Skld Defiance 16.44 -1.79 0.00 0.00 193.10

Page 22: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0378550 Morrow 2-S 113.36 63.85 10.79 1.19 2.60

0379880 Fulton 2-S 84.33 63.85 10.79 0.00 3.12

0380104 Montgomery 2-L 130.45 61.15 10.17 2.16 1.91

0380546 Lake 2-L 117.72 61.15 10.17 2.16 1.91

0380799 Tuscarawas 3-S 120.37 56.84 9.54 1.43 1.91

0383428 Franklin 2-S 115.45 63.85 10.79 1.52 2.60

0383498 Wood 2-S 107.91 63.85 10.79 1.96 1.91

0386336 Putnam 3-S 106.10 56.84 9.54 0.00 2.08

0387693 Richland 3-S 100.32 56.84 9.54 1.65 2.08

0388404 Summit 2-S 98.45 63.85 10.79 1.96 1.91

0388892 Mahoning 2-L 109.58 61.15 10.17 2.16 1.91

0389112 Cuyahoga 2-S 107.91 63.85 10.79 1.96 1.91

0389537 Summit 2-L 114.90 61.15 10.17 2.16 1.91

0390905 Monroe 3-S 94.85 56.84 9.54 1.43 1.91

0391562 Greene 2-S 117.80 63.85 10.79 0.02 1.04

0391571 Trumbull 2-L 102.60 61.15 10.17 0.04 2.60

0391580 Franklin 2-S 111.33 63.85 10.79 3.12 1.56

0393293 Trumbull 2-L 128.78 61.15 10.17 1.58 2.08

0394634 Guernsey 3-S 100.93 56.84 9.54 1.43 1.91

0394776 Fairfield 2-S 116.61 63.85 10.79 1.96 1.91

0394799 Hocking 3-L 100.62 57.68 7.99 1.43 1.91

0394829 Franklin 2-L 110.75 61.15 10.17 2.16 1.91

0394834 Warren 1-S 122.27 61.65 10.50 2.04 1.91 213.02502 Embassy Of Lebanon 16.44 -1.79 0.00 0.00

184.28

501 Embassy Of Winchester 16.44 -1.79 0.00 0.00 200.79

500 Embassy Of Logan 16.44 -1.79 0.00 0.00

185.30

499 Embassy Of Pickerington 16.44 -1.79 0.00 0.00 209.77

498 Embassy Of Cambridge 16.44 -1.79 0.00 0.00

214.23

497 Liberty Health Care Center, Inc. 16.44 -1.79 0.00 8.50 226.91

496 Mayfair Village Nursing Care

Center

16.44 -1.79 0.00 8.93

214.10

495 Community Skilled Health Care

Centre

16.44 -1.79 0.00 0.00 191.21

494 Trinity Community At Beavercreek 16.44 -1.79 0.00 5.95

204.94

493 Stellar Care Campus 16.44 -1.79 0.00 0.00 179.22

492 Divine Rehabilitation And Nursing

At Canal Pointe

16.44 -1.79 0.00 0.00

199.62

491 Village Of The Falls 16.44 -1.79 0.00 0.00 201.07

490 Park Vista Nursing & Rehab By

Mcare Health

16.44 -1.79 0.00 0.00

195.92

489 Hudson Elms Nursing Center 16.44 -1.79 0.00 0.00 191.61

488 Crystal Care Center Of Mansfield 16.44 -1.79 0.00 10.84

201.07

487 Hilty Memorial Home 16.44 -1.79 0.00 12.96 202.17

486 Heritage Corner Nursing Home 16.44 -1.79 0.00 0.00

204.74

485 Westerwood Rehabilitation 16.44 -1.79 0.00 10.84 219.70

484 New Dawn Rehabilitation And

Healthcare Center

16.44 -1.79 0.00 0.00

220.49

483 Kirtland Rehabilitation And Care 16.44 -1.79 0.00 0.00 207.76

482 Sycamore Glen Health Care 16.44 -1.79 0.00 0.00

224.29

481 Fulton Manor Nursing And

Rehabilitation Center

16.44 -1.79 0.00 11.90 188.64

480 Morrow Manor 16.44 -1.79 0.00 17.85

Page 23: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0394835 Franklin 2-S 118.22 63.85 10.79 1.96 1.91

0396218 Knox 2-S 115.32 63.85 10.79 1.41 2.08

0396339 Franklin 2-S 122.33 63.85 10.79 1.96 1.91

0397815 Hardin 3-S 93.20 56.84 9.54 0.00 1.56

0398642 Lorain 2-L 107.91 61.15 10.17 2.16 1.91

0399104 Washington 3-S 99.06 56.84 9.54 1.43 1.91

0399228 Summit 2-S 107.91 63.85 10.79 1.96 1.91

0400828 Tuscarawas 3-S 105.09 56.84 9.54 1.29 1.04

0401083 Trumbull 2-S 105.65 63.85 10.79 0.00 1.91

0402287 Trumbull 2-L 116.96 61.15 10.17 2.16 1.91

0403932 Sandusky 2-S 96.62 63.85 10.79 0.00 2.08

0403950 Stark 2-S 113.67 63.85 10.79 1.59 3.12

0404226 Franklin 2-L 106.05 61.15 10.17 0.00 1.04

0406392 Hamilton 1-S 122.02 61.65 10.50 2.04 1.91

0406484 Montgomery 2-L 110.57 61.15 10.17 1.87 2.60

0406804 Ashtabula 2-S 106.57 63.85 10.79 1.80 3.12

0406813 Hamilton 1-L 118.49 58.99 11.11 1.98 2.60

0408065 Cuyahoga 2-S 71.19 63.85 10.79 1.96 1.91

0408839 Pickaway 2-S 111.89 63.85 10.79 1.53 1.56

0409609 Putnam 3-S 99.96 56.84 9.54 0.79 0.00

0409645 Defiance 3-S 106.63 56.84 9.54 1.22 0.00

0409671 Franklin 2-S 114.41 63.85 10.79 3.88 0.00

0409693 Auglaize 3-S 113.50 56.84 9.54 1.27 0.00

209.14

525 Cridersville Nursing Home 16.73 0.00 0.00 0.00 197.88

524 Columbus Alzheimers 16.21 0.00 0.00 0.00

183.34

523 Brookview Healthcare Center 15.69 0.00 0.00 0.00 189.92

522 Autumn Court 16.21 0.00 0.00 0.00

164.35

521 Logan Elm Health Care 16.44 -1.79 0.00 8.71 212.98

520 Richmond Heights Place-A

Continuum Of Care Community

16.44 -1.79 0.00 0.00

214.17

519 Mt. Washington Care Center 16.44 -1.79 0.00 10.41 218.23

518 Rae Ann Geneva 16.44 -1.79 0.00 13.39

212.77

517 Brookhaven Nursing And

Rehabilitation Center

16.44 -1.79 0.00 9.78 210.79

516 Cottingham Retirement

Community

16.44 -1.79 0.00 0.00

221.91

515 Columbus Colony For Elderly Care 16.44 -1.79 0.00 14.03 207.09

514 Altercare Of Louisville Ctr For

Rehab & Nsg Care

16.44 -1.79 0.00 14.24

207.00

513 Bethesda Care Center 16.44 -1.79 0.00 0.00 187.99

512 Warren Nursing & Rehab 16.44 -1.79 0.00 0.00

198.23

511 Shepherd Of The Valley-Liberty 16.44 -1.79 0.00 0.00 196.85

510 Country Club Center I 16.44 -1.79 0.00 9.78

183.43

509 Timberland Ridge Nursing &

Rehabilitation

16.44 -1.79 0.00 0.00 201.07

508 Waterview Pointe Nursing &

Rehabilitation

16.44 -1.79 0.00 0.00

184.72

507 Avenue At North Ridgeville 16.44 -1.79 0.00 0.00 197.95

506 Hardin Hills Health Center 16.44 -1.79 0.00 8.93

222.76

505 Bella Terrace Rehab And Nursing

Center

16.44 -1.79 0.00 0.00 215.49

504 Country Club Retirement Center 16.44 -1.79 0.00 14.66

503 Embassy Of Woodview 16.44 -1.79 0.00 0.00 211.38

Page 24: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0409710 Richland 3-S 109.87 56.84 9.54 2.24 0.00

0409729 Franklin 2-S 116.61 63.85 10.79 3.88 0.00

0409786 Mercer 3-S 122.77 56.84 9.54 1.25 0.00

0409797 Mercer 3-S 122.13 56.84 9.54 2.29 0.00

0409812 Lucas 2-S 113.32 63.85 10.79 3.25 0.00

0409817 Stark 2-S 117.45 63.85 10.79 1.81 0.00

0409825 Paulding 3-S 114.32 56.84 9.54 3.01 0.00

0413725 Seneca 2-S 86.47 63.85 10.79 0.08 2.60

0414498 Franklin 2-S 107.91 63.85 10.79 1.96 1.91

0415394 Cuyahoga 2-S 109.92 63.85 10.79 2.98 1.04

0416722 Mahoning 2-L 116.74 61.15 10.17 1.79 1.56

0417109 Fairfield 2-S 125.29 63.85 10.79 2.83 0.00

0417154 Hamilton 1-L 121.59 58.99 11.11 2.92 0.00

0417297 Williams 3-S 97.31 56.84 9.54 1.23 0.00

0417416 Franklin 2-L 119.04 61.15 10.17 2.53 0.00

0419830 Hamilton 1-L 119.91 58.99 11.11 2.63 0.00

0420429 Guernsey 3-S 112.32 56.84 9.54 1.15 0.00

0420442 Butler 1-L 137.58 58.99 11.11 2.15 0.00

0420560 Butler 1-L 127.94 58.99 11.11 2.47 0.00

0420904 Clermont 1-S 109.84 61.65 10.50 0.00 2.60

0421991 Franklin 2-S 107.91 63.85 10.79 7.39 1.91

0422038 Belmont 3-S 90.81 56.84 9.54 1.00 0.00

0422999 Montgomery 2-S 108.32 63.85 10.79 1.96 0.00

0423769 Cuyahoga 2-L 122.35 61.15 10.17 0.00 2.60

200.61

549 Altenheim (The) 16.44 -1.79 0.00 13.18 224.10

548 Gem City Healthcare And

Rehabilitation Center Llc

15.69 0.00 0.00 0.00

206.50

547 Astoria Place Of Barnesville 16.73 0.00 0.00 0.00 174.92

546 Taylor Springs Health Campus 16.44 -1.79 0.00 0.00

217.76

545 Sem Haven Health & Residential

Care Center

16.44 -1.79 0.00 12.33 211.57

544 Majestic Care Of Fairfield 17.25 0.00 0.00 0.00

196.06

543 Majestic Care Of Middletown 16.21 0.00 0.00 0.00 226.04

542 Astoria Place Of Cambridge 16.21 0.00 0.00 0.00

208.06

541 Meadowbrook Care Center 16.73 0.00 0.00 0.00 209.37

540 Summit?S Trace Healthcare Center 15.17 0.00 0.00 0.00

210.30

539 Park View Nursing Center 16.21 0.00 0.00 0.00 181.13

538 Oak Pavilion Nursing Center 15.69 0.00 0.00 0.00

206.06

537 Echo Manor Extended Care Center 16.21 0.00 0.00 0.00 218.97

536 Omni Manor Health Care Center 16.44 -1.79 0.00 0.00

201.07

535 Algart Health Care, Inc. 16.44 -1.79 0.00 10.84 214.07

534 The Laurels Of West Columbus 16.44 -1.79 0.00 0.00

199.92

533 Autumnwood Care Center 16.44 -1.79 0.00 15.09 193.53

532 The Gardens At Paulding 16.21 0.00 0.00 0.00

207.94

531 Mccrea Manor Nursing &

Rehabilitation Center

16.21 0.00 0.00 0.00 210.11

530 Heatherdowns Rehabilitation &

Residential Center

16.73 0.00 0.00 0.00

206.61

529 The Gardens At St. Henry 17.25 0.00 0.00 0.00 208.05

528 The Gardens At Celina 16.21 0.00 0.00 0.00

194.18

527 Convalarium At Indian Run 16.73 0.00 0.00 0.00 211.86

526 Oak Grove Manor 15.69 0.00 0.00 0.00

Page 25: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0424044 Mahoning 2-S 106.29 63.85 10.79 2.76 1.56

0425346 Belmont 3-S 99.06 56.84 9.54 1.43 1.91

0426037 Warren 1-S 114.33 61.65 10.50 0.00 0.00

0426049 Stark 2-S 108.43 63.85 10.79 1.56 0.00

0426050 Mercer 3-S 94.73 56.84 9.54 1.00 0.00

0426052 Lucas 2-S 103.56 63.85 10.79 4.89 0.00

0426082 Clinton 1-S 123.77 61.65 10.50 0.01 0.00

0427411 Sandusky 2-L 135.41 61.15 10.17 2.16 0.00

0430028 Carroll 3-S 99.55 56.84 9.54 1.33 3.12

0433883 Cuyahoga 2-S 87.09 63.85 10.79 0.00 2.60

0438931 Greene 2-S 91.39 63.85 10.79 0.00 3.12

0455387 Trumbull 2-S 116.68 63.85 10.79 1.09 1.04

0459276 Lorain 2-S 119.96 63.85 10.79 1.75 2.60

0463903 Franklin 2-S 81.28 63.85 10.79 0.83 2.60

0479218 Mahoning 2-L 122.59 61.15 10.17 0.01 2.08

0489243 Lake 2-L 114.84 61.15 10.17 0.02 3.12

0493434 Hamilton 1-L 100.19 58.99 11.11 0.35 2.08

0520896 Wayne 3-S 94.47 56.84 9.54 0.00 2.60

0564125 Holmes 3-S 106.02 56.84 9.54 1.84 2.60

0571322 Ashtabula 2-S 124.73 63.85 10.79 1.66 2.60

0572376 Lorain 2-L 112.27 61.15 10.17 1.88 2.08

0574196 Stark 2-S 120.88 63.85 10.79 2.15 2.60

0575524 Lucas 2-S 120.94 63.85 10.79 0.02 2.60 224.33572 Otterbein Sunset House 16.44 -1.79 0.00 11.48

202.20

571 Bel-Air Care Center 16.44 -1.79 0.00 13.81 228.73

570 Northridge Health Center 16.44 -1.79 0.00 0.00

203.82

569 Country Club Retirement Center 16.44 -1.79 0.00 7.86 226.14

568 Majora Lane Center For

Rehabilitation And Nursing Care,

16.44 -1.79 0.00 12.33

187.37

567 Wayne County Care Center 16.44 -1.79 0.00 9.35 187.45

566 Twin Towers 16.44 -1.79 0.00 0.00

222.76

565 Ohio Living Breckenridge Village 16.44 -1.79 0.00 11.90 215.85

564 Crandall Medical Center 16.44 -1.79 0.00 12.11

225.50

563 Friendship Village Of Dublin

Health Center

16.44 -1.79 0.00 14.88 188.88

562 Elms Retirement Village, Inc. 16.44 -1.79 0.00 11.90

196.13

561 O'Brien Memorial Health Care

Center

16.44 -1.79 0.00 0.00 208.10

560 Friends Extended Care Center 16.44 -1.79 0.00 12.33

199.91

559 Judson Park 16.44 -1.79 0.00 10.63 189.61

558 Carroll Healthcare Center, Inc. 16.44 -1.79 0.00 14.88

213.18

557 Spring Creek Nursing And

Rehabilitation Center

15.17 0.00 0.00 0.00 224.06

556 Continental Manor Nursing And

Rehabilitation Center

17.25 0.00 0.00 0.00

178.84

555 Divine Rehabilitation And Nursing

At Toledo

15.69 0.00 0.00 0.00 198.78

554 Divine Rehabilitation And Nursing

At Shane Hill

16.73 0.00 0.00 0.00

203.21

553 Hall Of Fame Rehabilitation And

Nursing Center

16.21 0.00 0.00 0.00 200.84

552 Mason Health Care Center 16.73 0.00 0.00 0.00

199.90

551 East Ohio Regional Hospital Long

Term Care

16.44 -1.79 0.00 0.00 183.43

550 Guardian Health Care Center 16.44 -1.79 0.00 0.00

Page 26: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0580689 Stark 2-S 111.67 63.85 10.79 1.39 2.08

0580698 Summit 2-S 102.48 63.85 10.79 2.18 3.12

0585264 Champaign 2-S 110.77 63.85 10.79 0.00 1.04

0597939 Delaware 2-S 113.37 63.85 10.79 3.43 2.60

0609292 Huron 3-S 80.73 56.84 9.54 0.00 2.08

0610093 Wood 2-S 118.34 63.85 10.79 0.00 0.52

0612822 Cuyahoga 2-L 106.01 61.15 10.17 0.11 1.56

0619352 Franklin 2-S 109.80 63.85 10.79 0.00 2.08

0627558 Lorain 2-L 121.14 61.15 10.17 1.81 2.08

0640051 Belmont 3-S 108.04 56.84 9.54 1.94 1.56

0640739 Trumbull 2-S 116.72 63.85 10.79 1.71 2.08

0663947 Wayne 3-S 113.67 56.84 9.54 1.66 2.08

0668264 Trumbull 2-S 110.47 63.85 10.79 2.25 3.12

0680071 Hamilton 1-S 111.11 61.65 10.50 0.00 2.60

0682702 Cuyahoga 2-L 127.08 61.15 10.17 4.96 2.08

0684255 Montgomery 2-L 114.82 61.15 10.17 0.00 2.08

0689143 Scioto 3-S 94.86 56.84 9.54 0.61 2.60

0690060 Cuyahoga 2-S 130.95 63.85 10.79 4.81 2.08

0720385 Mahoning 2-L 125.89 61.15 10.17 1.82 2.08

0730043 Montgomery 2-S 115.92 63.85 10.79 2.64 2.60

0740041 Meigs 3-L 98.40 57.68 7.99 1.10 2.08

0750012 Jefferson 3-S 83.44 56.84 9.54 0.00 1.56

0760109 Cuyahoga 2-S 109.36 63.85 10.79 4.66 3.12

166.03

595 East Park Care Center 16.44 -1.79 0.00 0.00 206.43

594 Trinity Skilled Care Center 16.44 -1.79 0.00 0.00

225.96

593 Overbrook Center 16.44 -1.79 0.00 10.63 192.53

592 Grafton Oaks Nursing Center 16.44 -1.79 0.00 15.51

234.78

591 St. Mary'S Alzheimer'S Center 16.44 -1.79 0.00 12.11 227.87

590 Accord Care Community

Middleburg Heights

16.44 -1.79 0.00 7.65

215.62

589 Hill View Health Care Facility 16.44 -1.79 0.00 11.05 190.15

588 Bethany Village 16.44 -1.79 0.00 12.75

213.47

587 Pleasant Lake Villa 16.44 -1.79 0.00 9.35 229.44

586 St. Margaret Hall 16.44 -1.79 0.00 12.96

198.44

585 Gillette Nursing Home 16.44 -1.79 0.00 14.88 220.01

584 Doylestown Health Care Center 16.44 -1.79 0.00 0.00

205.32

583 Laurie Ann Nursing Home 16.44 -1.79 0.00 0.00 209.80

582 Country Club Retirement Center Iv 16.44 -1.79 0.00 12.75

214.35

581 O'Neill Healthcare North Ridgeville 16.44 -1.79 0.00 16.15 227.15

580 Worthington Christian Village, Inc. 16.44 -1.79 0.00 13.18

217.93

579 Eliza Bryant Village 16.44 -1.79 8.87 12.33 214.85

578 Otterbein-Portage Valley 16.44 -1.79 0.00 9.78

223.99

577 Norwalk Memorial Home 16.44 -1.79 0.00 9.14 172.98

576 Delaware Court 16.44 -1.79 0.00 15.30

212.58

575 Mercy Mcauley Center 16.44 -1.79 0.00 0.00 201.10

574 Stow Glen Health Care Center 16.44 -1.79 0.00 15.51

573 Meadow Wind Health Care Center,

Inc.

16.44 -1.79 0.00 0.00 204.43

Page 27: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0770116 Pike 3-S 91.39 56.84 9.54 0.00 3.12

0770241 Lucas 2-L 108.54 61.15 10.17 2.41 2.08

0770956 Clermont 1-L 128.17 58.99 11.11 2.19 1.56

0770965 Columbiana 3-S 110.28 56.84 9.54 1.48 1.04

0801332 Licking 2-S 140.99 63.85 10.79 1.57 0.52

0830506 Butler 1-S 107.06 61.65 10.50 2.40 3.12

0830766 Hamilton 1-L 95.97 58.99 11.11 0.00 1.56

0840068 Cuyahoga 2-S 122.92 63.85 10.79 0.00 2.60

0840157 Montgomery 2-L 103.04 61.15 10.17 3.72 1.04

0845036 Portage 2-S 113.34 63.85 10.79 3.19 3.12

0850539 Summit 2-L 115.98 61.15 10.17 2.18 1.56

0860064 Erie 3-L 97.40 57.68 7.99 0.00 2.60

0860091 Preble 2-S 108.71 63.85 10.79 1.93 2.08

0870580 Hamilton 1-L 133.31 58.99 11.11 2.46 1.56

0880793 Cuyahoga 2-S 98.16 63.85 10.79 5.05 1.04

0882880 Miami 2-L 121.21 61.15 10.17 0.00 1.56

0891585 Cuyahoga 2-L 138.79 61.15 10.17 0.00 1.04

0928223 Cuyahoga 2-L 109.40 61.15 10.17 0.00 1.56

0933806 Summit 2-L 91.26 61.15 10.17 0.00 2.08

0966012 Auglaize 3-S 111.48 56.84 9.54 0.00 2.08

0967137 Darke 2-L 114.60 61.15 10.17 0.08 1.56

0970927 Richland 3-L 101.89 57.68 7.99 1.88 0.52

0978358 Cuyahoga 2-L 115.03 61.15 10.17 3.70 1.56 211.79618 The Normandy Care Center 16.44 -1.79 0.00 5.53

212.62

617 Winchester Terrace 16.44 -1.79 0.00 0.00 184.61

616 Brethrens Home (The) 16.44 -1.79 0.00 10.41

186.54

615 Otterbein-St. Marys 16.44 -1.79 0.00 11.48 206.07

614 Regina Health Center 16.44 -1.79 0.00 7.23

230.26

613 Gardens Of Mcgregor And Amasa

Stone

16.44 -1.79 0.00 9.35 206.28

612 St. Augustine Manor 16.44 -1.79 0.00 4.46

193.54

611 Springmeade Health Center 16.44 -1.79 0.00 12.33 221.07

610 Crestmont North Nursing Home 16.44 -1.79 0.00 0.00

202.01

609 Brookwood Retirement Community 16.44 -1.79 0.00 15.09 237.17

608 The Greenbriar Nursing Center 16.44 -1.79 0.00 0.00

217.59

607 Providence Care Center 16.44 -1.79 0.00 13.18 193.50

606 Bath Manor Special Care Centre 16.44 -1.79 0.00 11.90

193.77

605 Aurora Manor Special Care Centre 16.44 -1.79 0.00 0.00 208.94

604 Walnut Creek Nursing Center 16.44 -1.79 0.00 0.00

196.09

603 Health Ctrs At The Renaissance 16.44 -1.79 0.00 15.30 230.11

602 Bayley 16.44 -1.79 0.00 13.81

241.72

601 Hawthorn Glen Nursing Center 16.44 -1.79 0.00 0.00 199.38

600 Pataskala Oaks Care Center 16.44 -1.79 0.00 9.35

231.76

599 Parkside Health Care Center 16.44 -1.79 0.00 0.00 193.83

598 Eastgate Health Care Center 16.44 -1.79 0.00 15.09

184.47

597 Foundation Park Alzheimer'S Care

Center

16.44 -1.79 0.00 15.09 214.09

596 National Church Residences Bristol

Village

16.44 -1.79 0.00 8.93

Page 28: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

0994090 Knox 2-L 125.54 61.15 10.17 1.85 2.08

1510298 Pickaway 2-S 97.38 63.85 10.79 0.00 2.08

2003996 Hamilton 1-L 129.69 58.99 11.11 3.34 1.04

2005850 Clark 2-L 105.51 61.15 10.17 0.00 1.04

2005903 Franklin 2-S 96.99 63.85 10.79 0.00 2.60

2017678 Franklin 2-S 122.32 63.85 10.79 5.56 2.60

2019612 Cuyahoga 2-S 87.08 63.85 10.79 5.73 3.12

2033490 Preble 2-S 119.99 63.85 10.79 2.12 2.60

2039690 Franklin 2-L 109.72 61.15 10.17 3.38 1.04

2041445 Allen 2-L 106.89 61.15 10.17 0.91 2.08

2044764 Hamilton 1-L 91.36 58.99 11.11 3.48 2.08

2045683 Franklin 2-L 113.48 61.15 10.17 3.80 2.60

2052399 Franklin 2-S 120.37 63.85 10.79 6.05 2.60

2055743 Montgomery 2-S 109.23 63.85 10.79 3.00 2.60

2056877 Cuyahoga 2-L 101.66 61.15 10.17 4.06 2.08

2056957 Butler 1-S 172.35 61.65 10.50 1.87 2.08

2058704 Warren 1-S 117.16 61.65 10.50 0.00 3.12

2058713 Clark 2-L 116.16 61.15 10.17 4.21 1.04

2095174 Mahoning 2-S 105.35 63.85 10.79 1.37 2.08

2101808 Delaware 2-S 95.40 63.85 10.79 0.00 2.08

2105868 Lorain 2-S 103.10 63.85 10.79 4.82 2.08

2106269 Hamilton 1-L 121.22 58.99 11.11 0.00 2.08

2112789 Franklin 2-S 124.96 63.85 10.79 3.58 2.08

222.08

641 Laurels Of Worthington (The) 16.44 -1.79 0.00 14.24 234.15

640 Mercy Health - West Park 16.44 -1.79 0.00 14.03

195.70

639 Life Care Center Of Elyria 16.44 -1.79 0.00 7.44 206.73

638 Ohio Living Sarah Moore 16.44 -1.79 0.00 8.93

216.73

637 Maplecrest Nursing And Home For

The Aged

16.44 -1.79 0.00 12.54 210.63

636 Oakwood Village 16.44 -1.79 0.00 9.35

263.10

635 Mcv Health Care Facilities, Inc. 16.44 -1.79 0.00 11.26 218.34

634 Parkside Nursing And

Rehabilitation Center

16.44 -1.79 0.00 0.00

217.30

633 Life Care Center Of Westlake 16.44 -1.79 0.00 14.45 208.22

632 Oak Creek Terrace 16.44 -1.79 0.00 13.18

220.51

631 New Albany Care Center 16.44 -1.79 0.00 10.20 228.51

630 Arlington Court Nursing And

Rehabilitation Center

16.44 -1.79 0.00 14.66

195.85

629 Anderson (The) 16.44 -1.79 0.00 10.41 192.08

628 Vancrest Of Delphos 16.44 -1.79 0.00 0.00

225.48

627 Whetstone Care Center 16.44 -1.79 0.00 8.29 208.40

626 Vancrest Health Care Center Of

Eaton

16.44 -1.79 0.00 11.48

236.35

625 Joshua Tree Care Center 16.44 -1.79 0.00 14.24 199.46

624 Mill Run Care Center 16.44 -1.79 0.00 16.58

203.36

623 Mohun Health Care Center 16.44 -1.79 0.00 13.81 202.69

622 Springfield Masonic Community 16.44 -1.79 0.00 10.84

188.75

621 Hillebrand Nursing And

Rehabilitation Center

16.44 -1.79 0.00 9.35 228.17

620 Brown Memorial Home, Inc. 16.44 -1.79 0.00 0.00

619 The Laurels Of Mt. Vernon 16.44 -1.79 0.00 14.66 230.10

Page 29: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

2112798 Franklin 2-L 113.87 61.15 10.17 3.65 2.60

2122018 Montgomery 2-S 107.65 63.85 10.79 0.07 2.60

2127166 Hamilton 1-L 123.98 58.99 11.11 3.07 3.12

2130750 Stark 2-L 104.56 61.15 10.17 2.95 2.60

2131277 Mahoning 2-S 122.90 63.85 10.79 0.00 1.04

2145762 Warren 1-L 136.76 58.99 11.11 0.73 2.60

2149571 Hamilton 1-L 135.03 58.99 11.11 3.19 2.08

2158301 Highland 3-S 105.65 56.84 9.54 1.02 2.60

2158418 Jackson 3-S 100.15 56.84 9.54 0.02 2.60

2161539 Morrow 2-S 120.18 63.85 10.79 2.62 1.56

2163386 Tuscarawas 3-L 127.16 57.68 7.99 2.48 3.64

2184363 Columbiana 3-S 129.04 56.84 9.54 1.87 2.08

2184792 Van Wert 3-S 96.01 56.84 9.54 1.19 2.08

2184818 Medina 2-S 126.13 63.85 10.79 2.05 1.04

2192121 Lucas 2-L 114.59 61.15 10.17 0.04 1.56

2194843 Fairfield 2-S 114.57 63.85 10.79 4.30 3.12

2203814 Greene 2-S 116.24 63.85 10.79 0.02 1.56

2206400 Cuyahoga 2-L 114.80 61.15 10.17 0.00 1.56

2218291 Clinton 1-S 103.86 61.65 10.50 0.88 2.60

2218602 Montgomery 2-L 116.54 61.15 10.17 0.00 1.04

2224800 Athens 3-S 84.42 56.84 9.54 1.97 1.04

2226997 Union 2-L 115.64 61.15 10.17 0.00 1.56

2235245 Ashtabula 2-S 128.47 63.85 10.79 2.43 2.08 237.36664 Jefferson Healthcare Center 16.44 -1.79 0.00 15.09

176.75

663 Memorial Gables 16.44 -1.79 0.00 10.41 213.58

662 Kimes Nursing And Rehabilitation

Center

16.44 -1.79 0.00 8.29

207.95

661 St. Leonard 16.44 -1.79 0.00 11.26 214.81

660 Autumn Years Nursing Center 16.44 -1.79 0.00 13.81

219.22

659 The Elisabeth Prentiss Center For

Skilled Nursing

16.44 -1.79 0.00 0.00 202.33

658 Trinity Community At Fairborn 16.44 -1.79 0.00 12.11

214.70

657 Lanfair Center For Rehabilitation

And Nursing Care, Inc.

16.44 -1.79 0.00 15.73 227.01

656 Franciscan Care Center 16.44 -1.79 0.00 12.54

193.06

655 Medina Meadows 16.44 -1.79 0.00 14.03 232.54

654 Sarah Jane Living Center 16.44 -1.79 0.00 12.75

231.24

653 Auburn Skilled Nursing And

Rehabilitation

16.44 -1.79 0.00 14.45 228.47

652 Hennis Care Centre Of Bolivar 16.44 -1.79 0.00 17.64

198.89

651 Bennington Glen Nursing And

Rehabilitation Center

16.44 -1.79 0.00 10.84 224.49

650 Four Winds Nursing Facility 16.44 -1.79 0.00 15.09

238.65

649 Laurels Of Hillsboro (The) 16.44 -1.79 0.00 13.18 203.48

648 Lodge Nursing & Rehab 16.44 -1.79 0.00 13.60

213.23

647 Hillspring Health Care And

Rehabilitation Center

16.44 -1.79 0.00 14.03 238.87

646 Humility House 16.44 -1.79 0.00 0.00

227.25

645 Mckinley Health Care Center (The) 16.44 -1.79 0.00 16.15 212.23

644 Western Hills Retirement Village 16.44 -1.79 0.00 12.33

219.69

643 Widows Home Of Dayton 16.44 -1.79 0.00 10.63 210.24

642 The Laurels Of Norworth 16.44 -1.79 0.00 13.60

Page 30: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

2239929 Clark 2-L 124.89 61.15 10.17 4.25 1.04

2259461 Summit 2-L 114.48 61.15 10.17 2.22 3.12

2262706 Tuscarawas 3-S 115.17 56.84 9.54 1.37 2.60

2262715 Ashtabula 2-S 146.98 63.85 10.79 2.43 2.60

2264964 Stark 2-L 110.91 61.15 10.17 2.24 2.08

2264973 Medina 2-L 110.52 61.15 10.17 2.16 2.08

2264991 Stark 2-S 117.15 63.85 10.79 1.85 3.12

2265016 Crawford 3-S 108.03 56.84 9.54 1.97 2.60

2265043 Fulton 2-S 113.61 63.85 10.79 2.27 2.60

2265052 Clark 2-S 73.80 63.85 10.79 1.79 2.08

2265061 Stark 2-S 114.95 63.85 10.79 1.37 2.60

2265070 Lake 2-L 108.98 61.15 10.17 2.90 2.08

2265329 Wayne 3-L 116.86 57.68 7.99 1.77 2.60

2267934 Hamilton 1-S 92.80 61.65 10.50 0.00 1.56

2276193 Lucas 2-S 116.81 63.85 10.79 0.07 2.08

2277316 Tuscarawas 3-L 118.86 57.68 7.99 1.94 2.60

2282453 Lorain 2-S 109.42 63.85 10.79 0.51 1.56

2282471 Cuyahoga 2-S 104.64 63.85 10.79 2.02 1.56

2288975 Cuyahoga 2-L 141.09 61.15 10.17 5.55 2.60

219.76

683 Parkside Villa 16.44 -1.79 0.00 16.79 252.00

682 Singleton Health Care Center 16.44 -1.79 9.07 13.18

217.96

681 Welcome Nursing Home 16.44 -1.79 0.00 13.39 214.17

680 Hennis Care Centre Of Dover 16.44 -1.79 0.00 14.24

193.49

679 Rosary Care Center 16.44 -1.79 0.00 16.15 224.40

678 Mount Notre Dame Health Center 16.44 -1.79 0.00 12.33

213.96

677 Smithville Western Care Center 16.44 -1.79 0.00 15.51 217.06

676 Altercare Of Mentor Center For

Rehabilitation & Nursing Care Inc

16.44 -1.79 0.00 14.03

183.54

675 Altercare Of Hartville Center For

Rehabilitation & Nursing Care Inc

16.44 -1.79 0.00 15.09 223.30

674 Good Shepherd Village 16.44 -1.79 0.00 16.58

206.59

673 Swanton Health Care And

Retirement Center

16.44 -1.79 0.00 13.60 221.37

672 Altercare Of Bucyrus Center For

Rehabilitation And Nursing Care,

Inc.

16.44 -1.79 0.00 12.96

215.39

671 Altercare Of Alliance Center For

Rehabilitation & Nursing Care Inc

16.44 -1.79 0.00 15.73 227.14

670 Altercare Of Wadsworth Center For

Rehabilitation And Nursing Care,

Inc.

16.44 -1.79 0.00 14.66

256.39

669 Altercare Of Navarre Center For

Rehabilitation And Nursing Care,

Inc.

16.44 -1.79 0.00 11.48 212.68

668 Andover Village Skilled Nursing &

Rehabilitation

16.44 -1.79 0.00 15.09

218.33

667 Schoenbrunn Healthcare 16.44 -1.79 0.00 13.18 213.35

666 Falls Village Retirement

Community

16.44 -1.79 0.00 12.54

665 Dayspring Of Miami Valley Health

Care Center And Rehabilitation

16.44 -1.79 0.00 11.69 227.84

Page 31: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

2294011 Franklin 2-S 111.83 63.85 10.79 3.75 3.12

2294093 Medina 2-S 110.42 63.85 10.79 3.77 2.08

2296297 Belmont 3-S 115.44 56.84 9.54 3.46 2.08

2296411 Lucas 2-S 100.19 63.85 10.79 0.03 2.60

2303046 Stark 2-L 125.26 61.15 10.17 1.61 2.08

2305482 Lucas 2-S 113.52 63.85 10.79 0.16 2.60

2313893 Wayne 3-S 117.00 56.84 9.54 2.86 1.56

2313946 Warren 1-S 118.76 61.65 10.50 2.38 2.60

2314650 Jefferson 3-S 102.55 56.84 9.54 1.83 1.56

2319566 Clark 2-L 111.01 61.15 10.17 2.45 1.56

2324934 Defiance 3-S 91.75 56.84 9.54 0.91 3.64

2334012 Tuscarawas 3-S 96.19 56.84 9.54 2.32 1.56

2339384 Hamilton 1-S 114.99 61.65 10.50 3.52 2.08

2339544 Summit 2-S 111.12 63.85 10.79 3.57 1.56

2339679 Butler 1-S 117.62 61.65 10.50 3.42 1.04

2342147 Lucas 2-S 91.57 63.85 10.79 0.00 2.08

2358701 Medina 2-S 134.59 63.85 10.79 1.64 2.08

2364052 Hamilton 1-S 131.56 61.65 10.50 4.95 1.56

2366103 Trumbull 2-S 96.84 63.85 10.79 0.00 3.12

2366112 Henry 3-S 108.85 56.84 9.54 1.34 2.08

2366416 Delaware 2-L 117.73 61.15 10.17 1.57 2.60

2391844 Hancock 2-L 123.62 61.15 10.17 0.00 3.12

2391853 Cuyahoga 2-S 115.18 63.85 10.79 6.35 1.56 225.98706 Altercare Of Mayfield Village, Inc. 16.44 -1.79 0.00 13.60

222.53

705 Birchaven Retirement Village 16.44 -1.79 0.00 13.81 226.52

704 Country View Of Sunbury 16.44 -1.79 0.00 14.66

206.68

703 Vancrest Health Care Center Of

Holgate

16.44 -1.79 0.00 14.24 207.54

702 Shepherd Of The Valley-Howland 16.44 -1.79 0.00 17.43

242.05

701 Home At Hearthstone (The) 16.44 -1.79 0.00 14.03 238.90

700 Pearlview Rehab And Wellness

Center

16.44 -1.79 0.00 14.45

221.21

699 Ursuline Center 16.44 -1.79 0.00 0.00 182.94

698 Golden Years Nursing Home 16.44 -1.79 0.00 12.33

222.48

697 Brentwood Health Care Center 16.44 -1.79 0.00 12.11 217.65

696 Terrace View Gardens 16.44 -1.79 0.00 15.09

191.99

695 Amberwood Manor 16.44 -1.79 0.00 14.45 195.55

694 Hickory Creek At Hicksville 16.44 -1.79 0.00 14.66

200.36

693 Southbrook Health Care Center,

Inc.

16.44 -1.79 0.00 16.15 217.14

692 Steubenville Country Club Manor 16.44 -1.79 0.00 13.39

211.80

691 Loveland Health Care Center 16.44 -1.79 0.00 17.43 227.97

690 Glendora Health Care Center 16.44 -1.79 0.00 9.35

214.92

689 Sunset Village 16.44 -1.79 0.00 8.50 214.07

688 Green Meadows Health And

Wellness Center

16.44 -1.79 0.00 0.00

210.72

687 Swan Creek Health Care Center 16.44 -1.79 0.00 9.56 201.67

686 Belmont Manor 16.44 -1.79 0.00 8.71

221.17

685 Western Reserve Masonic

Community, Inc.

16.44 -1.79 0.00 13.60 219.16

684 Crown Pointe Care Center 16.44 -1.79 0.00 13.18

Page 32: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

2410886 Summit 2-S 114.64 63.85 10.79 4.66 2.60

2411929 Richland 3-S 116.55 56.84 9.54 1.34 2.60

2420222 Portage 2-S 105.81 63.85 10.79 3.38 2.08

2422480 Trumbull 2-S 118.58 63.85 10.79 2.17 1.04

2424782 Richland 3-L 112.13 57.68 7.99 1.23 2.08

2429250 Stark 2-S 146.64 63.85 10.79 2.91 3.12

2431943 Hamilton 1-L 126.70 58.99 11.11 2.43 2.08

2431970 Butler 1-L 123.20 58.99 11.11 4.04 3.12

2432022 Butler 1-L 118.74 58.99 11.11 4.99 1.04

2432031 Hamilton 1-S 126.02 61.65 10.50 3.81 2.08

2437287 Fayette 2-S 116.27 63.85 10.79 1.56 2.60

2437303 Mercer 3-S 110.80 56.84 9.54 1.42 2.08

2437312 Wood 2-S 109.73 63.85 10.79 1.34 2.08

2437447 Miami 2-L 120.74 61.15 10.17 2.22 1.04

2437465 Allen 2-S 126.12 63.85 10.79 1.60 1.04

2437474 Hancock 2-L 110.24 61.15 10.17 1.58 1.56

2437885 Stark 2-S 108.97 63.85 10.79 2.74 1.56

2437894 Van Wert 3-S 104.48 56.84 9.54 1.07 2.60

2437974 Wood 2-L 112.77 61.15 10.17 4.01 2.08

2438017 Allen 2-L 124.82 61.15 10.17 1.78 2.08

2438026 Allen 2-S 139.44 63.85 10.79 1.23 2.60

2438053 Auglaize 3-S 107.61 56.84 9.54 1.29 2.08

2438099 Cuyahoga 2-S 132.42 63.85 10.79 3.98 2.08

204.76

729 Parma Care Center 16.44 -1.79 0.00 15.09 242.86

728 Wapakoneta Manor 16.44 -1.79 0.00 12.75

228.46

727 Roselawn Manor 16.44 -1.79 0.00 7.86 240.42

726 Shawnee Manor 16.44 -1.79 0.00 13.81

202.99

725 The Manor At Perrysburg 16.44 -1.79 0.00 16.15 220.98

724 Van Wert Manor 16.44 -1.79 0.00 13.81

211.68

723 Bethany Nursing Home, Inc. 16.44 -1.79 0.00 11.69 214.25

722 St. Catherine'S Manor Of Findlay 16.44 -1.79 0.00 12.33

222.08

721 Lima Manor 16.44 -1.79 0.00 14.03 232.08

720 Piqua Manor 16.44 -1.79 0.00 12.11

209.78

719 Bowling Green Manor 16.44 -1.79 0.00 12.75 215.19

718 Celina Manor 16.44 -1.79 0.00 14.45

218.71

717 St. Catherine'S Manor Of

Washington Court House

16.44 -1.79 0.00 10.63 220.35

716 Madeira Health Care Center 16.44 -1.79 0.00 0.00

228.50

715 Chesterwood Village 16.44 -1.79 0.00 10.63 220.15

714 Hillandale Health Care 16.44 -1.79 0.00 13.39

251.95

713 Kenwood Terrace Care Center 16.44 -1.79 0.00 0.00 215.96

712 Amherst Meadows 16.44 -1.79 0.00 9.99

219.58

711 Crestwood Care Center 16.44 -1.79 0.00 15.73 211.49

710 Windsor House At Champion 16.44 -1.79 0.00 8.50

218.10

709 Anna Maria Of Aurora 16.44 -1.79 0.00 12.96 213.52

708 Liberty Nursing Center Of

Mansfield

16.44 -1.79 0.00 16.58

707 Northfield Village Retirement

Community

16.44 -1.79 0.00 15.51 226.70

Page 33: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

2438115 Mahoning 2-L 137.30 61.15 10.17 2.01 2.60

2438124 Mahoning 2-L 136.00 61.15 10.17 2.03 2.08

2439356 Butler 1-S 119.90 61.65 10.50 2.37 1.56

2440308 Butler 1-S 102.60 61.65 10.50 0.00 2.08

2440424 Lucas 2-S 103.87 63.85 10.79 2.62 2.08

2442413 Hamilton 1-L 126.84 58.99 11.11 2.30 1.04

2442860 Mahoning 2-S 145.27 63.85 10.79 2.60 1.56

2444797 Summit 2-S 108.50 63.85 10.79 0.34 1.56

2444822 Tuscarawas 3-S 104.00 56.84 9.54 1.02 3.12

2450824 Stark 2-S 114.55 63.85 10.79 1.47 1.56

2457416 Cuyahoga 2-S 108.59 63.85 10.79 #### 2.08

2458620 Stark 2-S 112.45 63.85 10.79 1.50 1.56

2472613 Cuyahoga 2-S 108.33 63.85 10.79 4.25 1.56

2472622 Darke 2-S 112.49 63.85 10.79 1.50 1.04

2472631 Cuyahoga 2-S 146.09 63.85 10.79 3.40 2.08

2485672 Butler 1-S 115.47 61.65 10.50 1.94 3.12

2492388 Franklin 2-S 93.03 63.85 10.79 0.00 3.12

2499158 Stark 2-S 112.69 63.85 10.79 3.53 1.04

2506194 Cuyahoga 2-L 83.47 61.15 10.17 3.10 2.60

2508825 Allen 2-S 99.78 63.85 10.79 0.00 1.56

2509708 Butler 1-L 137.86 58.99 11.11 6.58 1.56

2510652 Erie 3-S 100.23 56.84 9.54 2.83 2.08

2515148 Cuyahoga 2-L 111.72 61.15 10.17 3.73 1.56 217.22752 O'Neill Healthcare Bay Village 16.44 -1.79 0.00 14.24

247.75

751 Mill Manor Nursing Home 16.44 -1.79 0.00 17.43 203.60

750 Heritagespring Health Care 16.44 -1.79 0.00 17.00

190.87

749 Lima Convalescent Home 16.44 -1.79 0.00 13.60 204.23

748 University Manor Health Care

Center

16.44 -1.79 0.00 15.73

193.09

747 Altercare Of Nobles Pond, Inc. 16.44 -1.79 0.00 11.69 218.24

746 Willow Brook Christian Home 16.44 -1.79 0.00 7.65

252.97

745 Residence At Huntington Court 16.44 -1.79 0.00 17.43 224.76

744 Heritage Nursing & Rehabilitation

Center Aka Grande Oaks

16.44 -1.79 0.00 12.11

221.28

743 Rest Haven Nursing Home, Inc. 16.44 -1.79 0.00 0.00 204.32

742 Heritage Health Care Center Dba

Grande Pavilion

16.44 -1.79 0.00 17.85

232.41

741 Oakhill Manor Care Center 16.44 -1.79 0.00 18.28 223.08

740 Crawford Manor Health Care

Center

16.44 -1.79 9.68 12.33

207.02

739 Canterbury Villa Of Alliance 16.44 -1.79 0.00 14.03 220.90

738 Claymont Nursing & Rehabilitation

Center

16.44 -1.79 0.00 17.85

249.56

737 St. Luke Lutheran Community-

Portage Lakes

16.44 -1.79 0.00 7.86 207.55

736 Caprice Health Care Center 16.44 -1.79 0.00 10.84

209.12

735 Ivy Woods Care Center 16.44 -1.79 0.00 11.48 226.41

734 Elizabeth Scott Community 16.44 -1.79 0.00 11.26

227.63

733 Knolls Of Oxford (The) 16.44 -1.79 0.00 10.41 201.89

732 Birchwood Care Center 16.44 -1.79 0.00 17.00

227.88

731 Briarfield Manor 16.44 -1.79 0.00 10.41 236.49

730 Briarfield At Ashley Circle 16.44 -1.79 0.00 0.00

Page 34: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

2515399 Stark 2-S 119.94 63.85 10.79 1.60 3.12

2515406 Mahoning 2-S 104.66 63.85 10.79 1.85 1.04

2515559 Clermont 1-L 135.79 58.99 11.11 2.38 1.04

2515577 Licking 2-L 125.06 61.15 10.17 1.88 1.04

2517520 Franklin 2-S 100.83 63.85 10.79 3.07 2.08

2524138 Delaware 2-S 92.91 63.85 10.79 0.00 1.56

2524450 Montgomery 2-S 104.38 63.85 10.79 3.80 2.60

2524469 Harrison 3-S 104.13 56.84 9.54 2.08 2.08

2524487 Harrison 3-S 96.89 56.84 9.54 1.73 2.08

2524496 Jefferson 3-L 104.08 57.68 7.99 3.02 1.56

2526038 Lucas 2-L 124.44 61.15 10.17 4.78 2.60

2527751 Lorain 2-S 125.52 63.85 10.79 0.00 2.08

2530489 Montgomery 2-L 111.29 61.15 10.17 4.18 2.08

2530498 Montgomery 2-L 117.84 61.15 10.17 5.20 1.56

2542636 Franklin 2-L 100.24 61.15 10.17 0.00 1.56

2550841 Franklin 2-L 133.89 61.15 10.17 3.26 2.08

2551519 Erie 3-S 102.95 56.84 9.54 2.31 1.56

2553286 Marion 2-S 110.76 63.85 10.79 1.57 2.08

2563926 Marion 2-S 118.95 63.85 10.79 2.77 2.08

2564523 Stark 2-L 111.73 61.15 10.17 1.77 3.12

2564541 Summit 2-L 122.78 61.15 10.17 3.54 1.56

2571908 Sandusky 2-S 126.87 63.85 10.79 1.28 2.08

2590352 Summit 2-L 118.40 61.15 10.17 2.96 2.60

219.52

775 Heather Knoll Retirement Village,

Inc.

16.44 -1.79 0.00 15.73 225.66

774 Windsor Lane Health Care 16.44 -1.79 0.00 0.00

214.92

773 Copley Health Center 16.44 -1.79 0.00 12.11 225.96

772 Hanover House 16.44 -1.79 0.00 12.33

218.58

771 Harding Pointe 16.44 -1.79 0.00 19.13 232.22

770 Marion Pointe 16.44 -1.79 0.00 14.88

239.44

769 Admiral'S Pointe Nursing &

Rehabilitation

16.44 -1.79 0.00 15.30 203.15

768 Mcnaughten Pointe Nursing &

Rehabilitation

16.44 -1.79 0.00 14.24

222.47

767 Mother Angeline Mccrory Manor 16.44 -1.79 0.00 10.20 197.97

766 Wood Glen Alzheimers Community 16.44 -1.79 0.00 11.90

216.89

765 Riverside Healthcare Center 16.44 -1.79 0.00 16.58 220.10

764 Wesleyan Village 16.44 -1.79 0.00 0.00

200.24

763 Kingston Care Center Sylvania 16.44 -1.79 0.00 12.33 230.12

762 Carriage Inn Of Steubenville 16.44 -1.79 0.00 11.26

200.80

761 Carriage Inn Of Cadiz 16.44 -1.79 0.00 7.65 189.38

760 Gables Care Center 16.44 -1.79 0.00 11.48

191.84

759 Carriage Inn Of Dayton 16.44 -1.79 0.00 0.00 200.07

758 Cherith Care Center At Willow

Brook

16.44 -1.79 0.00 8.08

227.55

757 Highbanks Care Center 16.44 -1.79 0.00 15.51 210.78

756 Arlington Care Center 16.44 -1.79 0.00 13.60

209.59

755 Batavia Nursing Care Center 16.44 -1.79 0.00 14.88 238.84

754 Ivy Woods Healthcare And

Rehabilitation Center

16.44 -1.79 0.00 12.75

753 Minerva Eldercare Center 16.44 -1.79 0.00 13.39 227.34

Page 35: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

2602044 Cuyahoga 2-L 105.90 61.15 10.17 0.00 1.56

2602295 Hamilton 1-S 97.11 61.65 10.50 0.36 3.12

2607067 Cuyahoga 2-L 111.50 61.15 10.17 4.68 2.08

2607085 Cuyahoga 2-L 119.73 61.15 10.17 5.65 2.08

2607101 Cuyahoga 2-L 120.48 61.15 10.17 3.49 1.04

2607110 Summit 2-L 127.34 61.15 10.17 2.82 3.12

2607156 Lorain 2-S 121.35 63.85 10.79 1.94 2.60

2607174 Summit 2-L 114.04 61.15 10.17 1.93 1.56

2611212 Montgomery 2-L 117.16 61.15 10.17 3.27 2.60

2611221 Lorain 2-L 113.14 61.15 10.17 4.11 1.56

2611230 Ashland 3-L 107.04 57.68 7.99 3.64 1.56

2617967 Summit 2-S 109.78 63.85 10.79 4.96 2.60

2618635 Hamilton 1-L 129.34 58.99 11.11 3.82 1.04

2642215 Stark 2-S 100.51 63.85 10.79 0.00 3.12

2658002 Hancock 2-S 109.96 63.85 10.79 2.10 1.56

2658253 Ottawa 2-S 141.56 63.85 10.79 2.47 1.04

2658262 Putnam 3-S 96.82 56.84 9.54 1.64 2.08

2658468 Allen 2-S 114.50 63.85 10.79 2.56 2.08

2667065 Athens 3-L 101.38 57.68 7.99 2.61 2.08

2667092 Montgomery 2-S 110.65 63.85 10.79 0.00 3.64

2671023 Ashtabula 2-S 123.45 63.85 10.79 3.14 3.12

2671032 Logan 3-S 91.52 56.84 9.54 0.00 2.08

2674904 Cuyahoga 2-L 122.79 61.15 10.17 4.15 3.12 234.31798 O'Neill Healthcare Lakewood 16.44 -1.79 0.00 18.28

234.94

797 Logan Acres Care Center 16.44 -1.79 0.00 13.60 188.23

796 Geneva Village Retirement

Community

16.44 -1.79 0.00 15.94

201.90

795 Grace Brethren Village 16.44 -1.79 0.00 0.00 203.58

794 Hickory Creek Nursing Center 16.44 -1.79 0.00 15.51

195.60

793 Springview Manor 16.44 -1.79 0.00 14.24 222.67

792 The Meadows Of Leipsic 16.44 -1.79 0.00 14.03

214.60

791 Genoa Retirement Village 16.44 -1.79 0.00 12.96 247.32

790 Heritage (The) 16.44 -1.79 0.00 11.69

236.38

789 Community Care Center 16.44 -1.79 0.00 10.84 203.76

788 Shawneespring Health Care Center 16.44 -1.79 0.00 17.43

203.40

787 The Merriman 16.44 -1.79 0.00 14.88 221.51

786 Kingston Of Ashland 16.44 -1.79 0.00 10.84

217.29

785 Kingston Of Vermilion 16.44 -1.79 0.00 9.56 214.34

784 Kingston Of Miamisburg 16.44 -1.79 0.00 8.29

227.08

783 Wyant Woods Care Center 16.44 -1.79 0.00 13.81 217.31

782 Lake Pointe Health Care 16.44 -1.79 0.00 11.90

223.73

781 Pebble Creek 16.44 -1.79 0.00 16.15 235.40

780 Greenbrier Health Care Center 16.44 -1.79 0.00 12.75

216.98

779 Grande Pointe Healthcare

Community

16.44 -1.79 0.00 14.03 227.46

778 Falling Water Healthcare Center 16.44 -1.79 0.00 12.75

204.69

777 Twin Lakes 16.44 -1.79 0.00 14.45 201.84

776 Mount Alverna Village 16.44 -1.79 0.00 11.26

Page 36: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

2675645 Hamilton 1-L 113.62 58.99 11.11 3.91 1.56

2675805 Medina 2-L 107.72 61.15 10.17 1.71 2.60

2679169 Warren 1-S 106.22 61.65 10.50 2.22 3.12

2686820 Montgomery 2-L 124.38 61.15 10.17 1.59 2.08

2691574 Hamilton 1-S 111.77 61.65 10.50 3.51 0.52

2691583 Mahoning 2-S 112.44 63.85 10.79 3.41 2.08

2692939 Morrow 2-S 116.67 63.85 10.79 1.69 2.60

2693741 Richland 3-S 106.22 56.84 9.54 1.90 2.60

2700090 Wayne 3-S 89.76 56.84 9.54 1.91 1.56

2700107 Wayne 3-S 95.80 56.84 9.54 2.47 2.60

2700116 Adams 3-S 101.26 56.84 9.54 1.24 1.56

2700125 Cuyahoga 2-L 107.79 61.15 10.17 #### 3.12

2703622 Summit 2-S 110.06 63.85 10.79 2.36 1.04

2705960 Clinton 1-S 116.65 61.65 10.50 2.82 1.56

2706012 Cuyahoga 2-L 137.25 61.15 10.17 3.17 0.52

2710749 Cuyahoga 2-L 101.54 61.15 10.17 0.00 2.08

2711337 Cuyahoga 2-S 119.83 63.85 10.79 5.58 0.52

2711346 Gallia 3-S 97.80 56.84 9.54 1.56 2.60

2712416 Trumbull 2-S 120.95 63.85 10.79 1.64 2.60

2717064 Ross 2-S 92.02 63.85 10.79 0.00 2.08

2717073 Trumbull 2-S 117.96 63.85 10.79 0.05 1.56

2736196 Hamilton 1-L 121.05 58.99 11.11 4.35 2.08

2736561 Cuyahoga 2-L 108.78 61.15 10.17 #### 2.60

212.23

821 Riverview Pointe Care Center 16.44 -1.79 0.00 18.49 226.51

820 Hyde Park Health Center 16.44 -1.79 0.00 0.00

190.19

819 Ohio Living Lake Vista 16.44 -1.79 0.00 5.53 214.39

818 National Church Residences

Chillicothe

16.44 -1.79 0.00 6.80

195.74

817 Cortland Healthcare Center 16.44 -1.79 0.00 14.03 228.51

816 Abbyshire Place Skilled Nursing

And Rehabilitation Center

16.44 -1.79 0.00 12.75

200.43

815 Southern Hills Health And

Rehabilitation Center

16.44 -1.79 0.00 0.00 215.22

814 Villa St. Joseph 16.44 -1.79 0.00 10.84

221.86

813 Beachwood Pointe Care Center 16.44 -1.79 0.00 11.05 237.96

812 Wilmington Nursing &

Rehabilitation Center

16.44 -1.79 0.00 14.03

223.58

811 Seasons Nursing And

Rehabilitation Center

16.44 -1.79 0.00 18.28 221.03

810 Willows Health And Rehab Center 16.44 -1.79 0.00 14.66

195.08

809 Eagle Creek Nursing Center 16.44 -1.79 0.00 8.50 193.59

808 Orrville Pointe 16.44 -1.79 0.00 13.18

206.63

807 Country Pointe 16.44 -1.79 0.00 12.75 187.01

806 Lexington Court Care Center 16.44 -1.79 0.00 14.88

222.73

805 Woodside Village Care Center 16.44 -1.79 0.00 7.23 217.48

804 Hampton Woods Nursing Center,

Inc.

16.44 -1.79 0.00 15.51

224.22

803 Home At Taylor'S Pointe (The) 16.44 -1.79 0.00 15.94 218.54

802 Friendship Village 16.44 -1.79 0.00 10.20

211.81

801 Carlisle Health Care, Inc. 16.44 -1.79 0.00 16.58 214.94

800 Life Care Center Of Medina 16.44 -1.79 0.00 13.81

799 Glendale Place Nursing & Rehab 16.44 -1.79 0.00 15.94 219.78

Page 37: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

2738416 Ashtabula 2-L 116.65 61.15 10.17 1.98 2.08

2739120 Columbiana 3-L 106.07 57.68 7.99 2.53 1.56

2750527 Summit 2-S 115.43 63.85 10.79 2.11 1.56

2751491 Hamilton 1-L 124.41 58.99 11.11 4.15 1.04

2751508 Clermont 1-S 125.24 61.65 10.50 1.50 1.56

2752436 Putnam 3-S 98.48 56.84 9.54 1.85 2.08

2758412 Licking 2-L 116.57 61.15 10.17 4.05 1.56

2765548 Belmont 3-S 134.26 56.84 9.54 2.47 1.56

2768107 Wood 2-S 113.20 63.85 10.79 0.00 2.08

2768116 Belmont 3-S 113.06 56.84 9.54 4.09 2.08

2768143 Ross 2-S 81.96 63.85 10.79 1.09 1.04

2772343 Coshocton 3-S 107.96 56.84 9.54 3.32 2.60

2773146 Montgomery 2-S 108.68 63.85 10.79 3.28 1.56

2776563 Ottawa 2-S 136.81 63.85 10.79 0.00 1.04

2777062 Lake 2-L 118.16 61.15 10.17 3.39 1.56

2784705 Cuyahoga 2-L 103.38 61.15 10.17 3.74 1.56

2786534 Butler 1-S 96.76 61.65 10.50 0.04 2.08

2789380 Lorain 2-L 126.73 61.15 10.17 3.07 1.56

2789791 Hancock 2-S 107.07 63.85 10.79 0.86 2.60

2791297 Crawford 3-S 82.55 56.84 9.54 1.71 2.60

2791377 Montgomery 2-L 94.53 61.15 10.17 3.32 1.04

2791402 Ross 2-S 113.62 63.85 10.79 1.68 1.04

2791519 Marion 2-L 101.66 61.15 10.17 1.67 1.04

2791537 Lake 2-L 93.96 61.15 10.17 2.05 1.04

199.69

845 Promedica Skilled Nursing And

Rehabilitation ( Mentor )

16.44 -1.79 0.00 0.00 183.02

844 Promedica Skilled Nursing And

Rehabilitation ( Marion )

16.44 -1.79 0.00 9.35

184.86

843 Promedica Skilled Nursing And

Rehabilitation ( Chillicothe )

16.44 -1.79 0.00 6.59 212.22

842 Promedica Skilled Nursing And

Rehabilitation ( Centerville )

16.44 -1.79 0.00 0.00

217.46

841 Promedica Skilled Nursing And

Rehabilitation ( Bucyrus )

16.44 -1.79 0.00 13.81 181.70

840 Independence House 16.44 -1.79 0.00 17.64

199.71

839 Main Street Care Center 16.44 -1.79 0.00 13.81 231.14

838 Westover Retirement Community 16.44 -1.79 0.00 14.03

223.53

837 Westpark Neurology And

Rehabilitation Center

16.44 -1.79 0.00 0.00 194.65

836 Wickliffe Country Place 16.44 -1.79 0.00 14.45

202.81

835 Otterbein North Shore 16.44 -1.79 0.00 0.00 227.14

834 Shiloh Springs Care Center 16.44 -1.79 0.00 0.00

177.63

833 Lafayette Pointe Nursing &

Rehabilitation Center

16.44 -1.79 0.00 12.96 207.87

832 Maple View Manor 16.44 -1.79 0.00 4.25

219.87

831 Emerald Pointe Health &

Rehabilitation Center

16.44 -1.79 0.00 12.11 212.37

830 Avalon By Otterbein Perrysburg 16.44 -1.79 0.00 15.30

223.45

829 Cumberland Pointe Care Center 16.44 -1.79 0.00 14.24 233.56

828 Tuscany Gardens 16.44 -1.79 0.00 15.30

232.74

827 Meadows Of Kalida 16.44 -1.79 0.00 15.94 199.38

826 Venetian Gardens 16.44 -1.79 0.00 17.64

223.48

825 Veranda Gardens Nursing &

Rehabilitation Center

16.44 -1.79 0.00 13.39 227.74

824 Manor Of Grande Village 16.44 -1.79 0.00 15.09

219.86

823 Blossom Nursing And

Rehabilitation Center

16.44 -1.79 0.00 7.86 198.34

822 Austinburg Nursing And

Rehabilitation Center

16.44 -1.79 0.00 13.18

Page 38: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

2791546 Montgomery 2-L 105.41 61.15 10.17 3.09 1.04

2791564 Lawrence 3-L 95.34 57.68 7.99 0.94 2.08

2791671 Highland 3-S 91.50 56.84 9.54 1.02 1.04

2791715 Montgomery 2-L 92.40 61.15 10.17 2.99 0.52

2791733 Washington 3-S 87.40 56.84 9.54 1.29 1.04

2791751 Wood 2-L 91.77 61.15 10.17 1.88 0.52

2791939 Summit 2-L 118.02 61.15 10.17 1.72 3.12

2791975 Greene 2-L 107.09 61.15 10.17 1.82 1.56

2792232 Cuyahoga 2-L 103.79 61.15 10.17 5.75 2.60

2792312 Lake 2-L 89.92 61.15 10.17 1.49 2.08

2792330 Franklin 2-L 108.88 61.15 10.17 3.42 1.04

2794856 Cuyahoga 2-S 122.98 63.85 10.79 5.50 1.56

2797862 Cuyahoga 2-L 120.58 61.15 10.17 4.52 2.08

2815458 Cuyahoga 2-S 125.50 63.85 10.79 3.80 1.56

2815467 Geauga 2-S 118.87 63.85 10.79 2.58 2.08

2815485 Franklin 2-L 124.11 61.15 10.17 3.66 1.56

2815494 Scioto 3-S 121.59 56.84 9.54 1.75 2.08

2815510 Mahoning 2-L 121.53 61.15 10.17 3.09 2.60

2815538 Cuyahoga 2-L 120.76 61.15 10.17 4.64 2.60

2818839 Darke 2-S 105.14 63.85 10.79 1.33 2.08

2818857 Seneca 2-S 113.02 63.85 10.79 1.49 1.56

2819436 Wood 2-S 122.99 63.85 10.79 1.87 2.60

2819454 Lucas 2-S 119.80 63.85 10.79 0.00 1.56 216.60868 Otterbein Monclova 16.44 -1.79 0.00 5.95

219.81

867 Briar Hill Health Campus 16.44 -1.79 0.00 15.09 231.84

866 St. Catherine'S Manor Of Fostoria 16.44 -1.79 0.00 14.45

227.78

865 Union City Care Center 16.44 -1.79 0.00 9.14 206.98

864 Northwestern Healthcare Center 16.44 -1.79 0.00 13.81

223.45

863 Greenbriar Healthcare Center 16.44 -1.79 0.00 10.20 223.39

862 Bridgeport Healthcare Center 16.44 -1.79 0.00 17.00

229.18

861 Columbus Healthcare Center 16.44 -1.79 0.00 12.75 228.05

860 Chardon Healthcare Center 16.44 -1.79 0.00 16.36

228.88

859 Berea Alzheimer'S Care Center 16.44 -1.79 0.00 15.94 236.09

858 Diplomat Healthcare 16.44 -1.79 0.00 15.73

209.51

857 Solon Pointe At Emerald Ridge, Llc 16.44 -1.79 0.00 16.15 235.48

856 Promedica Skilled Nursing And

Rehabilitation ( Westerville )

16.44 -1.79 0.00 10.20

210.86

855 Promedica Skilled Nursing And

Rehabilitation ( Willoughby )

16.44 -1.79 0.00 14.24 193.70

854 Manorcare Health Services-Parma 16.44 -1.79 0.00 12.75

226.47

853 Promedica Skilled Nursing And

Rehabilitation ( Beavercreek )

16.44 -1.79 0.00 7.01 203.45

852 Promedica Skilled Nursing And

Rehabilitation ( Barberton )

16.44 -1.79 0.00 17.64

182.45

851 Promedica Skilled Nursing And

Rehabilitation (Perrysburg)

16.44 -1.79 0.00 12.11 192.25

850 Promedica Skilled Nursing

Rehabilitation (Marietta)

16.44 -1.79 0.00 11.69

186.07

849 Promedica Skilled Nursing And

Rehabilitation ( Kettering )

16.44 -1.79 0.00 11.69 193.57

848 Promedica Skilled Nursing And

Rehabilitation ( Hillsboro )

16.44 -1.79 0.00 11.48

195.51

847 Promedica Skilled Nursing And

Rehabilitation ( Riverview )

16.44 -1.79 0.00 9.35 188.03

846 Promedica Skilled Nursing And

Rehabilitation ( Miamisburg )

16.44 -1.79 0.00 0.00

Page 39: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

2826928 Cuyahoga 2-S 118.44 63.85 10.79 4.16 1.04

2900641 Sandusky 2-S 111.54 63.85 10.79 3.53 1.04

2900678 Holmes 3-S 104.74 56.84 9.54 1.04 2.60

2900687 Champaign 2-S 103.56 63.85 10.79 2.89 1.56

2900883 Warren 1-S 113.72 61.65 10.50 1.78 1.04

2900918 Jefferson 3-S 110.55 56.84 9.54 3.44 2.08

2901999 Hamilton 1-S 115.00 61.65 10.50 4.98 1.56

2902327 Portage 2-S 119.77 63.85 10.79 3.88 3.12

2902390 Montgomery 2-L 112.98 61.15 10.17 3.48 1.56

2902587 Franklin 2-S 113.52 63.85 10.79 6.78 3.12

2902845 Warren 1-S 136.16 61.65 10.50 0.00 1.56

2903004 Ross 2-S 110.26 63.85 10.79 2.63 1.04

2903040 Crawford 3-S 121.12 56.84 9.54 0.35 1.56

2903120 Lorain 2-L 113.01 61.15 10.17 0.54 2.08

2903620 Franklin 2-S 109.99 63.85 10.79 7.04 1.56

2904307 Montgomery 2-S 131.36 63.85 10.79 0.45 2.08

2904423 Lorain 2-S 106.31 63.85 10.79 2.52 2.08

2904727 Wayne 3-S 111.53 56.84 9.54 1.74 3.12

2908205 Clark 2-S 95.19 63.85 10.79 2.34 1.56

2927659 Mercer 3-L 102.91 57.68 7.99 1.05 2.60

2941526 Warren 1-S 119.07 61.65 10.50 0.00 2.08

2947360 Mahoning 2-S 132.58 63.85 10.79 3.62 1.56 238.53890 Masternick Memorial Health Care

Center

16.44 -1.79 0.00 11.48

203.67

889 Otterbein Middletown 16.44 -1.79 0.00 14.88 222.83

888 Briarwood Village 16.44 -1.79 0.00 16.79

213.36

887 Springfield Nursing And

Independent Living

16.44 -1.79 0.00 17.00 205.38

886 Autumnwood Nursing &

Rehabilation Center

16.44 -1.79 0.00 15.94

236.78

885 Oak Hills Nursing Center 16.44 -1.79 0.00 0.00 200.20

884 Pinnacle Pointe Nursing And

Rehabilitation

16.44 -1.79 0.00 13.60

217.75

883 Trueman Pointe Care Center 16.44 -1.79 0.00 8.93 216.81

882 Keystone Pointe Health And

Rehabilitation

16.44 -1.79 0.00 16.15

203.22

881 Mill Creek Nursing &

Rehabilitation

16.44 -1.79 0.00 16.58 220.64

880 Vineyards At Concord (The) 16.44 -1.79 0.00 0.00

227.37

879 Otterbein Springboro 16.44 -1.79 0.00 13.81 238.33

878 Altercare Of Canal Winchester Post-

Acute Rehabilitation Center

16.44 -1.79 0.00 14.66

232.64

877 Maria Joseph Living Care Center 16.44 -1.79 0.00 17.85 221.84

876 Altercare Post-Acute Rehabilitation

Center, Inc.

16.44 -1.79 0.00 16.58

211.98

875 Triple Creek Retirement

Community

16.44 -1.79 0.00 11.26 219.60

874 The Laurels Of Steubenville 16.44 -1.79 0.00 14.88

201.55

873 Franklin Ridge Healthcare Center 16.44 -1.79 0.00 13.18 216.52

872 Vancrest Of Urbana, Inc. 16.44 -1.79 0.00 4.25

217.30

871 Walnut Hills Nursing Home 16.44 -1.79 0.00 12.96 202.37

870 The Willows At Bellevue 16.44 -1.79 0.00 11.90

869 Huntington Woods Care &

Rehabilitation Center

16.44 -1.79 0.00 14.45 227.38

Page 40: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

2956127 Belmont 3-S 111.68 56.84 9.54 3.36 2.08

2987200 Columbiana 3-S 116.32 56.84 9.54 0.74 2.60

2990054 Lake 2-L 94.22 61.15 10.17 1.51 2.60

2990483 Hamilton 1-L 129.52 58.99 11.11 9.75 1.04

2993560 Butler 1-S 105.10 61.65 10.50 0.04 2.08

2994925 Clinton 1-S 122.91 61.65 10.50 2.13 1.04

3000291 Scioto 3-S 115.50 56.84 9.54 1.19 2.60

3002717 Cuyahoga 2-S 96.39 63.85 10.79 0.00 0.52

3003967 Hamilton 1-S 133.90 61.65 10.50 2.06 1.56

3006893 Ashtabula 2-S 129.77 63.85 10.79 0.91 1.04

3022259 Montgomery 2-S 104.73 63.85 10.79 4.55 1.56

3040060 Franklin 2-S 110.03 63.85 10.79 5.26 1.04

3047803 Hamilton 1-S 109.66 61.65 10.50 0.00 2.08

3060744 Crawford 3-S 110.66 56.84 9.54 1.89 1.56

3060762 Richland 3-S 107.28 56.84 9.54 1.32 1.56

3072400 Franklin 2-L 115.15 61.15 10.17 7.05 2.08

3072688 Montgomery 2-L 124.13 61.15 10.17 5.35 1.56

3074266 Wayne 3-S 110.05 56.84 9.54 4.69 1.56

3074275 Hamilton 1-S 123.23 61.65 10.50 7.76 2.08

3075363 Stark 2-S 131.29 63.85 10.79 2.58 1.56

3078842 Morgan 3-S 87.02 56.84 9.54 1.64 2.60

3083327 Warren 1-S 127.18 61.65 10.50 0.00 2.60

3083336 Cuyahoga 2-S 137.99 63.85 10.79 5.14 1.04

230.61

913 Avenue Care And Rehabilitation

Center (The)

16.44 -1.79 0.00 9.99 243.45

912 Otterbein At Maineville 16.44 -1.79 0.00 14.03

235.77

911 Highland Oaks Health Center 16.44 -1.79 0.00 16.36 188.65

910 Astoria Skilled Nursing And

Rehabilitation

16.44 -1.79 0.00 11.05

210.51

909 Forest Hills Care Center 16.44 -1.79 0.00 10.63 230.50

908 Burbank Parke Care Center 16.44 -1.79 0.00 13.18

223.00

907 Stonespring Of Vandalia 16.44 -1.79 0.00 15.73 232.74

906 Darby Glenn Nursing &

Rehabilitation Center

16.44 -1.79 0.00 12.75

207.04

905 Shelby Pointe 16.44 -1.79 0.00 15.30 206.49

904 Galion Pointe 16.44 -1.79 0.00 11.90

217.10

903 Deupree Cottages 16.44 -1.79 0.00 12.11 210.65

902 The Laurels Of Hilliard 16.44 -1.79 0.00 11.48

233.55

901 Cypress Pointe Health Campus 16.44 -1.79 0.00 15.51 215.64

900 Saybrook Landing 16.44 -1.79 0.00 12.54

192.15

899 Pleasant Ridge Care Center 16.44 -1.79 0.00 9.14 233.46

898 Mcgregor At Overlook 16.44 -1.79 0.00 5.95

225.21

897 Concord Health & Rehabilitation

Center

16.44 -1.79 0.00 15.73 216.05

896 Laurels Of Blanchester (The) 16.44 -1.79 0.00 12.33

238.45

895 Berkeley Square Retirement Center 16.44 -1.79 0.00 16.36 210.38

894 Indianspring Of Oakley 16.44 -1.79 0.00 13.39

214.29

893 Madison Health Care 16.44 -1.79 0.00 18.49 202.79

892 Covington Skilled Nursing And

Rehabiliation

16.44 -1.79 0.00 13.60

891 Park Health Center 16.44 -1.79 0.00 12.96 211.11

Page 41: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912

3098464 Knox 2-S 95.44 63.85 10.79 2.77 2.60

3098473 Medina 2-S 113.47 63.85 10.79 4.24 2.08

3102127 Mahoning 2-S 113.84 63.85 10.79 3.35 1.04

3108256 Lucas 2-L 111.36 61.15 10.17 0.04 2.08

3108292 Henry 3-S 84.87 56.84 9.54 0.04 2.08

3108309 Lucas 2-S 96.73 63.85 10.79 0.07 1.56

3118816 Stark 2-L 114.94 61.15 10.17 3.47 2.08

3147277 Wood 2-S 103.64 63.85 10.79 2.27 2.08

3147295 Sandusky 2-S 124.01 63.85 10.79 1.46 1.56

3293921 Seneca 2-L 103.65 61.15 10.17 0.00 1.56

4366958 Cuyahoga 2-L 103.36 61.15 10.17 0.00 1.56

5345200 Cuyahoga 2-L 115.00 61.15 10.17 0.00 2.08

5489850 Richland 3-S 92.88 56.84 9.54 0.00 1.04

6161755 Clermont 1-S 114.37 61.65 10.50 1.73 2.08

6543502 Shelby 3-L 100.55 57.68 7.99 0.04 1.04

6635172 Ottawa 2-L 93.49 61.15 10.17 0.00 2.08

6636331 Warren 1-L 122.88 58.99 11.11 0.00 2.60

6975662 Summit 2-L 100.19 61.15 10.17 1.89 2.60

7295289 Scioto 3-S 113.44 56.84 9.54 0.69 1.56

7648808 Stark 2-L 111.42 61.15 10.17 0.01 1.04

7968472 Wayne 3-L 104.26 57.68 7.99 1.44 2.08 204.04934 Shady Lawn Nursing Home 16.44 -1.79 0.00 15.94

206.07

933 St. Luke Lutheran Home 16.44 -1.79 0.00 0.00 198.44

932 Rest Haven Nursing Home 16.44 -1.79 0.00 9.35

226.59

931 Pleasant View Health Care Center 16.44 -1.79 0.00 16.15 206.80

930 Otterbein-Lebanon Retirement

Community

16.44 -1.79 0.00 16.36

188.11

929 Ottawa County Riverview Nursing

Home

16.44 -1.79 0.00 16.15 197.69

928 Dorothy Love Retirement

Community

16.44 -1.79 0.00 6.16

184.94

927 Morris Nursing Home 16.44 -1.79 0.00 12.75 217.73

926 Geriatric Center Of Mansfield

Memorial Homes

16.44 -1.79 0.00 9.99

199.82

925 Lutheran Home At Concord

Reserve

16.44 -1.79 0.00 11.69 214.74

924 Menorah Park Center For Senior

Living

16.44 -1.79 0.00 8.93

228.86

923 Good Shepherd Home 16.44 -1.79 0.00 6.59 197.77

922 Bellevue Care Center 16.44 -1.79 0.00 12.54

220.91

921 Grand Rapids Care Center 16.44 -1.79 0.00 8.08 205.36

920 Rose Lane Health And

Rehabilitation

16.44 -1.79 0.00 14.45

172.48

919 Lutheran Home At Toledo 16.44 -1.79 0.00 8.71 196.36

918 Lutheran Home 16.44 -1.79 0.00 4.46

207.52

917 Lutheran Village At Wolf Creek 16.44 -1.79 0.00 5.10 204.55

916 Danridge'S Burgundi Manor 16.44 -1.79 0.00 0.00

204.34

915 Wadsworth Pointe 16.44 -1.79 0.00 16.36 225.44

914 Centerburg Pointe 16.44 -1.79 0.00 14.24

Page 42: Provider Rate Component Data Report(NF) : Effective Date ......2021/01/01  · 0041672 Hamilton 1-S 102.01 61.65 10.50 0.00 2.60 0050215 Cuyahoga 2-L 105.79 61.15 10.17 4.79 2.08 0050912