NPIMap

Organization Active NPI

Outpatient Mobile Solutions, Inc.

  • Occupational Therapist
  • North Grosvenordale, CT
National Provider Identifier
1114484987
Registry record updated Apr 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
OUTPATIENT MOBILE SOLUTIONS, INC.
Practice address
113 Labby Rd
North Grosvenordale, CT 06255-1247
Phone
(607) 278-6209
NPI assigned
Feb 27, 2019
Last updated
Apr 16, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2020

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

Authorized official

Name
Dr. Tanya Lee Clark, OTD, OTR/LNPI 1427485192
Title
Incorporator
Phone
(860) 497-0239

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X NU
Physical Therapist 225100000X NU
Physical Therapy Assistant 225200000X NU
Occupational Therapist 225X00000X NU Primary
Speech-Language Pathologist 235Z00000X NU

Addresses

Primary practice location

113 Labby Rd
North Grosvenordale, CT 06255-1247

Mailing address

113 Labby Rd
North Grosvenordale, CT 06255-1247
Phone (860) 497-0239

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT, MA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190610000437 CT Part B Supplier - Clinic/Group Practice 8224361159 Receives reassigned benefits from 2 practitioners
Practice locations: North Grosvenordale, CT
O20191216002278 MA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8224361159 Receives reassigned benefits from 2 practitioners
Practice locations: Worcester, MA

National Provider Directory

National Provider Directory

Locations

365 Main St
Ste 101
Worcester, MA 01608
Phone (860) 497-0239

Practitioners & affiliated clinicians

Practitioners 6

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": "1551225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586995200000",
    "number": "1114484987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 LABBY RD",
            "city": "NORTH GROSVENORDALE",
            "state": "CT",
            "postal_code": "062551247",
            "telephone_number": "860-497-0239",
            "fax_number": "860-497-0047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 LABBY RD",
            "city": "NORTH GROSVENORDALE",
            "state": "CT",
            "postal_code": "062551247",
            "telephone_number": "607-278-6209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OUTPATIENT MOBILE SOLUTIONS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-27",
        "last_updated": "2020-04-16",
        "certification_date": "2020-04-16",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "TANYA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "INCORPORATOR",
        "authorized_official_telephone_number": "860-497-0239",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OTD, OTR/L"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in North Grosvenordale, CT

Sources for this page

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