NPIMap

Organization Active NPI

Southern Colorado Health & Rehab

Doing business as Momentum Physical Therapy of Pueblo

  • Physical Therapy Clinic/Center
  • Pueblo, CO
National Provider Identifier
1093322547
Registry record updated Sep 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
SOUTHERN COLORADO HEALTH & REHAB
Doing business as
Momentum Physical Therapy of Pueblo
Practice address
1630 Fortino Blvd
Pueblo, CO 81008-1856
Phone
(719) 281-3184
Fax
(719) 299-4088
NPI assigned
Sep 29, 2020
Last updated
Sep 29, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
SOUTHERN COLORADO HEALTH & REHAB LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 29, 2020

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

Authorized official

Name
Blaine Stimac, MSPT
Title
Managing Member
Phone
(406) 756-1128

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X NU Primary

Addresses

Primary practice location

1630 Fortino Blvd
Pueblo, CO 81008-1856

Mailing address

PO Box 5718
Kalispell, MT 59903-5718
Phone (406) 756-0134

Other names 1

  • Momentum Physical Therapy of Pueblo Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160914000646 CO Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5799071924 Receives reassigned benefits from 15 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Pueblo, CO

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
Southern Colorado Health R

Locations

1275 W Pueblo Blvd
Pueblo, CO 81004
Phone (719) 542-0589

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1601337600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601337600000",
    "number": "1093322547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5718",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599035718",
            "telephone_number": "406-756-0134",
            "fax_number": "406-300-1612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 FORTINO BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810081856",
            "telephone_number": "719-281-3184",
            "fax_number": "719-299-4088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN COLORADO HEALTH & REHAB",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOUTHERN COLORADO HEALTH & REHAB LLC",
        "enumeration_date": "2020-09-29",
        "last_updated": "2020-09-29",
        "certification_date": "2020-09-29",
        "status": "A",
        "authorized_official_last_name": "STIMAC",
        "authorized_official_first_name": "BLAINE",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "406-756-1128",
        "authorized_official_credential": "MSPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Momentum Physical Therapy of Pueblo",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2020; 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.