NPIMap

Organization Active NPI

Permian Basin Rehabilitation Center for Crippled Children and Adults

  • Comprehensive Outpatient Rehabilitation Facility (CORF)
  • Odessa, TX
National Provider Identifier
1104958701
Registry record updated Feb 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Comprehensive Outpatient Rehabilitation Facility (CORF)Taxonomy code 261QR0401X
Legal business name
PERMIAN BASIN REHABILITATION CENTER FOR CRIPPLED CHILDREN AND ADULTS
Practice address
620 N Alleghaney Ave
Odessa, TX 79761-4408
Phone
(432) 332-8244
Fax
(432) 580-7428
NPI assigned
Mar 9, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2025

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

Authorized official

Name
Kimberly Ruby OrtegaNPI 1952628711
Title
Executive Director
Phone
(432) 332-8244

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Comprehensive Outpatient Rehabilitation Facility (CORF) 261QR0401X Primary

Addresses

Primary practice location

620 N Alleghaney Ave
Odessa, TX 79761-4408

Mailing address

620 N Alleghaney Ave
Odessa, TX 79761-4408
Phone (432) 332-8244

Other identifiers 4

IdentifierTypeStateIssuer
051CTOtherTXBCBS GROUP NUMBER
531269OtherTXBCBS HEARING AID ID NUM
5589378OtherTXAETNA BILLING NUM
094460501MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031024000050 TX Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 1254243942 Practice locations: Odessa, TX

National Provider Directory

National Provider Directory
Tax ID family
Permian Basin Rehabilitation Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Practitioners & affiliated clinicians

Practitioners 59

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

View all 59

NPI Registry JSON

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739145600000",
    "number": "1104958701",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 N ALLEGHANEY AVE",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797614408",
            "telephone_number": "432-332-8244",
            "fax_number": "432-580-7428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 N ALLEGHANEY AVE",
            "city": "ODESSA",
            "state": "TX",
            "postal_code": "797614408",
            "telephone_number": "432-332-8244",
            "fax_number": "432-580-7428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERMIAN BASIN REHABILITATION CENTER FOR CRIPPLED CHILDREN AND ADULTS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-09",
        "last_updated": "2025-02-10",
        "certification_date": "2025-02-10",
        "status": "A",
        "authorized_official_last_name": "ORTEGA",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "RUBY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "432-332-8244"
    },
    "taxonomies": [
        {
            "code": "261QR0401X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "051CT",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS HEARING AID ID NUM",
            "identifier": "531269",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA BILLING NUM",
            "identifier": "5589378",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "094460501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Odessa, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2025; 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.