NPIMap

Organization Active NPI

Serc Rehabilitation Partners, LLC

Doing business as SERC - Liberty

  • Physical Therapy Clinic/Center
  • Kansas City, MO
National Provider Identifier
1083978522
Registry record updated Dec 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
SERC REHABILITATION PARTNERS, LLC
Doing business as
SERC - Liberty
Practice address
9760 N Ash Ave
Kansas City, MO 64157-9742
Phone
(816) 792-0775
Fax
(816) 407-9400
NPI assigned
Jun 29, 2012
Last updated
Dec 1, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2015

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

Authorized official

Name
Kevin Johanneson
Title
VP Revenue Cycle Operations
Phone
(423) 238-7217

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X
Physical Therapy Clinic/Center 261QP2000X Primary
Occupational Medicine Clinic/Center 261QX0100X

Addresses

Primary practice location

9760 N Ash Ave
Kansas City, MO 64157-9742

Mailing address

8823 Production LN
Ooltewah, TN 37363-6511
Phone (423) 238-7217

Other names 1

  • SERC - Liberty Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130304000500 MO Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9830344563 Receives reassigned benefits from 207 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lake Ozark, MO; Lees Summit, MO; Mount Vernon, MO; Kansas City, MO; Oak Grove, MO; Odessa, MO; Platte City, MO; Pleasant Hill, MO…

Other NPIs on the same Medicare enrollment 18

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 18

National Provider Directory

National Provider Directory

Locations

9760 N Ash Ave
Kansas City, MO 64157
Phone (816) 792-0775

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1340928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448928000000",
    "number": "1083978522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8823 PRODUCTION LN",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373636511",
            "telephone_number": "423-238-7217",
            "fax_number": "423-238-3473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9760 N ASH AVE",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641579742",
            "telephone_number": "816-792-0775",
            "fax_number": "816-407-9400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERC REHABILITATION PARTNERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-29",
        "last_updated": "2015-12-01",
        "status": "A",
        "authorized_official_last_name": "JOHANNESON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "VP REVENUE CYCLE OPERATIONS",
        "authorized_official_telephone_number": "423-238-7217"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SERC - Liberty",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kansas City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2015; 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.