NPIMap

Organization Active NPI

Ellerbrock Spine and Soft Tissue Services LLC

  • Clinic/Center
  • Bluffton, OH
National Provider Identifier
1205205259
Registry record updated Feb 10, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
2927 Issued in OH
Legal business name
ELLERBROCK SPINE AND SOFT TISSUE SERVICES LLC
Practice address
120 N Main St
Suite a
Bluffton, OH 45817-1246
Phone
(419) 358-2222
Fax
(419) 358-2223
NPI assigned
Sep 21, 2015
Last updated
Feb 10, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2016

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

Authorized official

Name
Dr. Matthew P Ellerbrock, D.C.NPI 1417021692
Title
Owner
Phone
(419) 659-2271

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
Clinic/Center 261Q00000X 2927 OH Primary

Addresses

Primary practice location

120 N Main St
Suite a
Bluffton, OH 45817-1246

Mailing address

120 N. Main St.
Bluffton, OH 45817-1250
Phone (419) 358-2222

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160217000028 OH Part B Supplier - Clinic/Group Practice 2466762356 Receives reassigned benefits from 2 practitioners
Practice locations: Bluffton, OH

National Provider Directory

National Provider Directory

Locations

120 N Main St
Bluffton, OH 45817
Phone (419) 358-2222

120 N Main St
Ste A
Bluffton, OH 45817
Phone (419) 358-2222

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": "1442793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1455062400000",
    "number": "1205205259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 N. MAIN ST.",
            "city": "BLUFFTON",
            "state": "OH",
            "postal_code": "458171250",
            "telephone_number": "419-358-2222",
            "fax_number": "419-358-2223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 N MAIN ST",
            "address_2": "SUITE A",
            "city": "BLUFFTON",
            "state": "OH",
            "postal_code": "458171246",
            "telephone_number": "419-358-2222",
            "fax_number": "419-358-2223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELLERBROCK SPINE AND SOFT TISSUE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-21",
        "last_updated": "2016-02-10",
        "status": "A",
        "authorized_official_last_name": "ELLERBROCK",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "419-659-2271",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "OH",
            "license": "2927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bluffton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2016; 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.