NPIMap

Organization Active NPI

Five Star Rehabilitation and Wellness Services, LLC

  • Physical Therapy Clinic/Center
  • Kokomo, IN
National Provider Identifier
1124773338
Registry record updated Oct 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
FIVE STAR REHABILITATION AND WELLNESS SERVICES, LLC
Practice address
2501 Friendship Blvd
Kokomo, IN 46901-4199
Phone
(765) 454-0001
NPI assigned
Feb 16, 2022
Organization subpart
Yes
Parent organization
FIVE STAR REHABILITATION AND WELLNESS SERVICES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 20, 2022

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

Authorized official

Name
Jeffrey C Leer
Title
President & Chief Executive Officer
Phone
(617) 796-8350

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

2501 Friendship Blvd
Kokomo, IN 46901-4199

Mailing address

255 Washington St Ste 230
Newton, MA 02458-1644
Phone (617) 793-8350

Other names 1

  • Ageility Physical Therapy Solutions at Northwoods Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221215000856 IN Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0143323535 Receives reassigned benefits from 5 practitioners
Practice locations: Elkhart, IN

Other NPIs with the same Medicare PAC ID 7

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

National Provider Directory

National Provider Directory
Tax ID family
Five Star Rehab7 organizations share this tax ID, including this one
Part of
Five Star Rehab

Other organizations with this tax ID 6

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

Practitioners & affiliated clinicians

Practitioners 6

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": "1644969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666224000000",
    "number": "1124773338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 WASHINGTON ST STE 230",
            "city": "NEWTON",
            "state": "MA",
            "postal_code": "024581644",
            "telephone_number": "617-793-8350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 FRIENDSHIP BLVD",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469014199",
            "telephone_number": "765-454-0001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIVE STAR REHABILITATION AND WELLNESS SERVICES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FIVE STAR REHABILITATION AND WELLNESS SERVICES, LLC",
        "enumeration_date": "2022-02-16",
        "last_updated": "2022-10-20",
        "certification_date": "2022-10-20",
        "status": "A",
        "authorized_official_last_name": "LEER",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT & CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "617-796-8350"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ageility Physical Therapy Solutions at Northwoods",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Ageility Physical Therapy Solutions at Northwoods",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kokomo, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2022; 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.