NPIMap

Organization Active NPI

SMR Banyan Tree, Inc.

  • Physical Therapist
  • Dublin, OH
National Provider Identifier
1164458329
Registry record updated Nov 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
SMR BANYAN TREE, INC.
Practice address
5130 Bradenton Ave
Suite B
Dublin, OH 43017-7068
Phone
(614) 336-8733
Fax
(614) 336-0658
NPI assigned
Jun 22, 2006
Last updated
Nov 21, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2018

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

Authorized official

Name
Mr. Michael E Tarvin
Title
Vice President & Secretary
Phone
(717) 972-1100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X
Physical Therapist 225100000X Primary

Addresses

Primary practice location

5130 Bradenton Ave
Suite B
Dublin, OH 43017-7068

Mailing address

4714 Gettysburg Rd
Legal Dept
Mechanicsburg, PA 17055-4325
Phone (717) 972-1100

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051109000052 OH Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 2961420880 10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Warren, OH

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

207 Interstate Park Dr
Montgomery, AL 36109

5130 Bradenton Ave
Dublin, OH 43017
Phone (614) 734-1100

3148 Broadway
Grove City, OH 43123
Phone (614) 539-4646

953 E Aurora Rd
Macedonia, OH 44056
Phone (330) 468-6070

700 Beta Dr
Ste 500R
Mayfield Village, OH 44143
Phone (440) 460-2488

32 W Broad St
Newton Falls, OH 44444
Phone (330) 872-0308

53 E Main St
Orwell, OH 44076
Phone (440) 437-5378

3262 Center Rd
Ste B
Poland, OH 44514
Phone (330) 707-1190

1060 N Market St
Troy, OH 45373
Phone (937) 335-9800

140 Highland Terrace Blvd
Warren, OH 44484
Phone (330) 505-9668

925 N State St
Ste G
Westerville, OH 43082
Phone (614) 865-8733

Practitioners & affiliated clinicians

Practitioners 8

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": "1150934400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542758400000",
    "number": "1164458329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4714 GETTYSBURG RD",
            "address_2": "LEGAL DEPT",
            "city": "MECHANICSBURG",
            "state": "PA",
            "postal_code": "170554325",
            "telephone_number": "717-972-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5130 BRADENTON AVE",
            "address_2": "SUITE B",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430177068",
            "telephone_number": "614-336-8733",
            "fax_number": "614-336-0658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMR BANYAN TREE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-22",
        "last_updated": "2018-11-21",
        "status": "A",
        "authorized_official_last_name": "TARVIN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "VICE PRESIDENT & SECRETARY",
        "authorized_official_telephone_number": "717-972-1100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dublin, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2018; 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.