NPIMap

Organization Active NPI

Stellar Health Care

Doing business as Phenomenal Rehabilitation

  • Physical Therapy Clinic/Center
  • Howard Lake, MN
National Provider Identifier
1174556682
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
STELLAR HEALTH CARE
Doing business as
Phenomenal Rehabilitation
Practice address
1116 Sixth Street
Howard Lake, MN 55349-0737
Phone
(320) 543-1104
Fax
(320) 543-1105
NPI assigned
Jul 8, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Craig ButturffNPI 1376577742
Title
Ceo
Phone
(320) 543-1104

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 Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

1116 Sixth Street
Howard Lake, MN 55349-0737

Mailing address

PO Box 737
Howard Lake, MN 55349-0737
Phone (320) 543-1104

Other names 1

  • Phenomenal Rehabilitation Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040424000343 MN Part B Supplier - Clinic/Group Practice 3971599861 Receives reassigned benefits from 5 practitioners
Practice locations: Rockford, MN; Plymouth, MN; Howard Lake, MN; Dassel, MN

National Provider Directory

National Provider Directory
Tax ID family
Phenomenal Rehabilitation2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

109 5th St NE
Little Falls, MN 56345
Phone (320) 631-1103

109 5th St NE
#1
Little Falls, MN 56345
Phone (320) 631-1103

6050 Main St
Apt 101
Rockford, MN 55373
Phone (320) 543-1104

921 Central Ave E
Ste 200
Saint Michael, MN 55376
Phone (763) 497-1152

Practitioners & affiliated clinicians

Practitioners 12

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": "1152316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1174556682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 737",
            "city": "HOWARD LAKE",
            "state": "MN",
            "postal_code": "553490737",
            "telephone_number": "320-543-1104",
            "fax_number": "320-543-1105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1116 SIXTH STREET",
            "city": "HOWARD LAKE",
            "state": "MN",
            "postal_code": "553490737",
            "telephone_number": "320-543-1104",
            "fax_number": "320-543-1105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STELLAR HEALTH CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BUTTURFF",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "320-543-1104"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Phenomenal Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Howard Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.