NPIMap

Organization Active NPI

St. Vincent Pediatric Rehabilitation Center, Inc.

  • Children's Hospital
  • Indianapolis, IN
National Provider Identifier
1245270834
Registry record updated Oct 16, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Children's HospitalTaxonomy code 282NC2000X
Legal business name
ST. VINCENT PEDIATRIC REHABILITATION CENTER, INC.
Practice address
1707 W. 86TH St.
Indianapolis, IN 46240
Phone
(317) 415-5500
Fax
(317) 415-5595
NPI assigned
Jun 8, 2006
Last updated
Oct 16, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2007

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

Authorized official

Name
Jeff Poltawsky
Title
Administrator
Phone
(317) 415-5522

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Children's Hospital 282NC2000X IN Primary

Addresses

Primary practice location

1707 W. 86TH St.
Indianapolis, IN 46240

Mailing address

1707 W. 86TH St.
Indianapolis, IN 46240
Phone (317) 415-5500

Other names 1

  • St. Vincent Children's Specialty Hospital, Inc. Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245270834. Details of each certification follow.

Hospital certification: CCN 153026

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
LIFELINES CHILDREN'S REHAB HOSPITAL
Certification status
Terminated Other: provider status change, Jan 1, 1995
Provider type (POS)
Hospital – Rehabilitation
Participating since
Sep 15, 1989
Last certification
Aug 5, 1994
Beds
59
Ownership / control type
Private (for profit)
Facility address
1707 W 86TH St, PO Box 40407
Indianapolis, IN 46240

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192492800000",
    "number": "1245270834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1707 W. 86TH ST.",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46240",
            "telephone_number": "317-415-5500",
            "fax_number": "317-415-5595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1707 W. 86TH ST.",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "46240",
            "telephone_number": "317-415-5500",
            "fax_number": "317-415-5595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. VINCENT PEDIATRIC REHABILITATION CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-08",
        "last_updated": "2007-10-16",
        "status": "A",
        "authorized_official_last_name": "POLTAWSKY",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "317-415-5522"
    },
    "taxonomies": [
        {
            "code": "282NC2000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Children",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Vincent Children's Specialty Hospital, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.