NPIMap

S.P.O.R.T. Physical Therapy Clinic

A Medicare group practice based in Lewiston, ID: 2 NPIs enrolled under one PECOS associate control ID (PAC ID 6507764180), with 6 clinicians.

Medicare enrollment

Medicare enrollment files
PAC ID
6507764180The PECOS associate control ID: one enrolled organization, which may hold several NPIs
Provider type
DME Supplier - Independently-Practicing Physical Therapist, Part B Supplier - Clinic/Group Practice
Enrolled in
ID
Enrollments
2
Group size
4 cliniciansAs Care Compare reports it
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Practice locations
3In 1 place

Enrollment records 2

Enrollment IDStateProvider typeNPI
O20031219000773 ID Part B Supplier - Clinic/Group Practice 1215011754
O20100930072521 ID DME Supplier - Independently-Practicing Physical Therapist 1215011754

NPIs in this group 2

NPPES NPI Registry

These NPI records belong to the same enrolled organization. Each has its own page.

Practice locations

Locations on the Medicare enrollment

Clinicians 6

Clinicians who reassign their Medicare benefits to this group (6) or whom Care Compare lists as members (4).

Sources for this page