NPIMap

Organization Active NPI

KNCC Enterprise, LLC

  • Physical Therapist
  • Springfield, OH
National Provider Identifier
1124324116
Registry record updated Apr 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
KNCC ENTERPRISE, LLC
Practice address
155 South Tuttle Road
Springfield, OH 45505
Phone
(937) 717-6436
NPI assigned
Feb 8, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2017

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

Authorized official

Name
Casey YoungNPI 1619933629
Title
Owner
Phone
(937) 408-2682

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
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

155 South Tuttle Road
Springfield, OH 45505

Mailing address

155 South Tuttle Road
Springfield, OH 45505
Phone (937) 717-6436

Other names 1

  • Tuttle Rehab Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110608000217 OH Part B Supplier - Clinic/Group Practice 7810174406 Receives reassigned benefits from 2 practitioners
Practice locations: Springfield, OH; Fairborn, OH

National Provider Directory

National Provider Directory
Tax ID family
KNCC Enterprise LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

7590 Dayton Springfield Rd
#C
Fairborn, OH 45324

7774 Dayton Springfield Rd
Ste C
Fairborn, OH 45324
Phone (937) 340-6261

155 S Tuttle Rd
Springfield, OH 45505
Phone (937) 717-6436

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1297123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492646400000",
    "number": "1124324116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 SOUTH TUTTLE ROAD",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "45505",
            "telephone_number": "937-717-6436"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 SOUTH TUTTLE ROAD",
            "city": "SPRINGFIELD",
            "state": "OH",
            "postal_code": "45505",
            "telephone_number": "937-717-6436"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KNCC ENTERPRISE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-08",
        "last_updated": "2017-04-20",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "CASEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "937-408-2682"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tuttle Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Springfield, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2017; 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.