NPIMap

Organization Active NPI

Orthopedic Edge LLC

  • Physical Therapy Clinic/Center
  • Shelby TWP, MI
National Provider Identifier
1164682399
Registry record updated Jun 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
5501010159 Issued in MI
Legal business name
ORTHOPEDIC EDGE LLC
Practice address
51064 Filomena Dr
Shelby TWP, MI 48315-2937
Phone
(586) 566-5116
Fax
(586) 566-5146
NPI assigned
Jun 11, 2008
Last updated
Jun 11, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2008

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

Authorized official

Name
Mr. Erick B Fountain, PTNPI 1255529434
Title
Member
Phone
(248) 761-3530

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 5501010776 MI
Physical Therapy Clinic/Center 261QP2000X 5501010159 MI Primary

Addresses

Primary practice location

51064 Filomena Dr
Shelby TWP, MI 48315-2937

Mailing address

51064 Filomena Dr
Shelby TWP, MI 48315-2937
Phone (586) 566-5116

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080725000131 MI Part B Supplier - Clinic/Group Practice 1153494018 Receives reassigned benefits from 6 practitioners
Practice locations: Shelby TWP, MI; Troy, MI

National Provider Directory

National Provider Directory

Locations

51064 Filomena Dr
Shelby Township, MI 48315
Phone (586) 531-6860

4850 Investment Dr
Ste B
Troy, MI 48098
Phone (248) 641-5010

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": "1213142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213142400000",
    "number": "1164682399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51064 FILOMENA DR",
            "city": "SHELBY TWP",
            "state": "MI",
            "postal_code": "483152937",
            "telephone_number": "586-566-5116",
            "fax_number": "586-566-5146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51064 FILOMENA DR",
            "city": "SHELBY TWP",
            "state": "MI",
            "postal_code": "483152937",
            "telephone_number": "586-566-5116",
            "fax_number": "586-566-5146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPEDIC EDGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-11",
        "last_updated": "2008-06-11",
        "status": "A",
        "authorized_official_last_name": "FOUNTAIN",
        "authorized_official_first_name": "ERICK",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "248-761-3530",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MI",
            "license": "5501010776",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MI",
            "license": "5501010159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelby TWP, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2008; 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.