NPIMap

Organization Active NPI

Cani PT OT SLP & Psychology PLLC

  • Specialist
  • Watertown, NY
National Provider Identifier
1114065174
Registry record updated Sep 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
CANI PT OT SLP & PSYCHOLOGY PLLC
Practice address
19472 US Route 11
Watertown, NY 13601-5387
Phone
(315) 782-6126
Fax
(315) 782-3816
NPI assigned
Feb 2, 2007
Last updated
Sep 16, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2008

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

Authorized official

Name
Mr. James Frederick Pemberton, PTNPI 1417925108
Title
Owner Physical Therapist
Phone
(315) 782-6126

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
Specialist 174400000X NU Primary

Addresses

Primary practice location

19472 US Route 11
Watertown, NY 13601-5387

Mailing address

19472 US Route 11
Watertown, NY 13601-5387
Phone (315) 782-6126

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050228000455 NY Part B Supplier - Clinic/Group Practice 0648223875 Receives reassigned benefits from 11 practitioners
Practice locations: Mexico, NY; Pulaski, NY; Watertown, NY

National Provider Directory

National Provider Directory
Tax ID family
Cani PT OT SLP Psychology2 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 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1221523200000",
    "number": "1114065174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19472 US ROUTE 11",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136015387",
            "telephone_number": "315-782-6126",
            "fax_number": "315-782-3816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19472 US ROUTE 11",
            "city": "WATERTOWN",
            "state": "NY",
            "postal_code": "136015387",
            "telephone_number": "315-782-6126",
            "fax_number": "315-782-3816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANI PT OT SLP & PSYCHOLOGY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-02",
        "last_updated": "2008-09-16",
        "status": "A",
        "authorized_official_last_name": "PEMBERTON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "FREDERICK",
        "authorized_official_title_or_position": "OWNER PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "315-782-6126",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2008; 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.