NPIMap

Organization Active NPI

Easter Seals Rehabilitation Center, Inc.

  • Adolescent and Children Mental Health Clinic/Center
  • Evansville, IN
National Provider Identifier
1003979964
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent and Children Mental Health Clinic/CenterTaxonomy code 261QM0855X
Legal business name
EASTER SEALS REHABILITATION CENTER, INC.
Practice address
3701 Bellemeade Ave
Evansville, IN 47714-0137
Phone
(812) 479-1411
Fax
(812) 437-2636
NPI assigned
Dec 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Authorized official

Name
Mr. Rea Tecson
Title
Cfo
Phone
(812) 479-1411

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental Disabilities Clinic/Center 261QD1600X
Adult Mental Health Clinic/Center 261QM0850X
Adolescent and Children Mental Health Clinic/Center 261QM0855X Primary

Addresses

Primary practice location

3701 Bellemeade Ave
Evansville, IN 47714-0137

Mailing address

3701 Bellemeade Ave
Evansville, IN 47714-0137
Phone (812) 479-1411

Other identifiers 1

IdentifierTypeStateIssuer
200263500AMedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080407000063 IN Part B Supplier - Clinic/Group Practice 8426135179 Receives reassigned benefits from 11 practitioners
Practice locations: Evansville, IN

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Easter Seals Rehabilitation5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705968000000",
    "number": "1003979964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3701 BELLEMEADE AVE",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477140137",
            "telephone_number": "812-479-1411",
            "fax_number": "812-437-2636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 BELLEMEADE AVE",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477140137",
            "telephone_number": "812-479-1411",
            "fax_number": "812-437-2636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTER SEALS REHABILITATION CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A",
        "authorized_official_last_name": "TECSON",
        "authorized_official_first_name": "REA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "812-479-1411",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200263500A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.