NPIMap

Organization Active NPI

Effingham Rehab Services, LLC

Doing business as CORA Physical Therapy - Pooler

  • Rehabilitation Clinic/Center
  • Pooler, GA
National Provider Identifier
1124541685
Registry record updated Oct 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
EFFINGHAM REHAB SERVICES, LLC
Doing business as
CORA Physical Therapy - Pooler
Practice address
123 Canal St Ste 203
Pooler, GA 31322-4104
Phone
(912) 988-1283
Fax
(912) 988-1652
NPI assigned
Jul 17, 2017
Last updated
Oct 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2023

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

Authorized official

Name
Mr. Stephen Krzyminski
Title
Executive Vice President
Phone
(419) 221-6717

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X GA Primary

Addresses

Primary practice location

123 Canal St Ste 203
Pooler, GA 31322-4104

Mailing address

PO Box 150
Lima, OH 45802-0150
Phone (419) 221-6717

Other names 1

  • CORA Physical Therapy - Pooler Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20171025001724 GA Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 5597752063 7 other NPIs on this enrollment
Practice locations: Pembroke, GA; Savannah, GA; Richmond Hill, GA; Pooler, GA; Hinesville, GA; Rincon, GA
O20180723000980 GA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5597752063 Receives reassigned benefits from 13 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Brunswick, GA; Jesup, GA; Kingsland, GA; Pooler, GA; Savannah, GA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124541685. Details of each certification follow.

  • CCN 116904 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 116904

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
CORA PHYSICAL THERAPY - POOLER
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Sep 20, 2018
Last certification
May 3, 2022
Ownership / control type
Proprietary
Facility address
123 Canal Street, Suite 203
Pooler, GA 31322

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory

Locations

111 Jazie Dr
Ste E
Savannah, GA 31410
Phone (912) 898-7714

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1500249600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1124541685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 150",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458020150",
            "telephone_number": "419-221-6717",
            "fax_number": "419-222-0507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 CANAL ST STE 203",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313224104",
            "telephone_number": "912-988-1283",
            "fax_number": "912-988-1652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EFFINGHAM REHAB SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-07-17",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "KRZYMINSKI",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "EXECUTIVE  VICE PRESIDENT",
        "authorized_official_telephone_number": "419-221-6717",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "GA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CORA Physical Therapy - Pooler",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CORA Physical Therapy - Pooler",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pooler, GA

Sources for this page

Verify at the official NPI Registry.