NPIMap

Organization Active NPI

Rehabilitation Hospital of Indiana, Inc.

  • Rehabilitation Hospital
  • Indianapolis, IN
National Provider Identifier
1255406369
Registry record updated Feb 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation HospitalTaxonomy code 283X00000X
License
06-005971-1 Issued in IN
Legal business name
REHABILITATION HOSPITAL OF INDIANA, INC.
Practice address
4141 Shore Dr
Indianapolis, IN 46254-2607
Phone
(317) 329-2000
Fax
(317) 329-2600
NPI assigned
Nov 22, 2006
Last updated
Feb 11, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2015

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

Authorized official

Name
Mr. Joseph Saffa
Title
Dir Acct Finance
Phone
(317) 329-2000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital 283X00000X 06-005971-1 IN Primary

Addresses

Primary practice location

4141 Shore Dr
Indianapolis, IN 46254-2607

Mailing address

4141 Shore Dr
Indianapolis, IN 46254-2607
Phone (317) 329-2000

Other identifiers 5

IdentifierTypeStateIssuer
68192OtherINMMG
000000097990OtherINANTHEM PIN
100274620AMedicaidIN
I014220OtherINCHAMPUS
016661POtherINSIHO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041110001099 IN Part B Supplier - Clinic/Group Practice 4385553676 Receives reassigned benefits from 3 practitioners
Practice locations: Indianapolis, IN
O20050901000056 IN Part A Provider - Hospital 4385553676 Practice locations: Indianapolis, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255406369. Details of each certification follow.

Hospital certification: CCN 153028

Legal name
REHABILITATION HOSPITAL OF INDIANA INC
Certification status
Active
Provider type (POS)
Hospital – Rehabilitation
Participating since
Feb 10, 1992
Last certification
Mar 12, 2003
Beds
91
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Feb 10, 1992 in IN
Enrollment address
4141 Shore Dr
Indianapolis, IN 46254-2607
Main/Primary Hospital Location
Hospital subgroups
General, Rehabilitation

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Rehabilitation Hospital of Indiana IncCCN 153028 · All quality measures
Ownership
Non-profit
Certified
Feb 10, 1992
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Rehabilitation Hospital of Indiana Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

5404 Reliable Pkwy
Chicago, IL 60686

2001 W 86th St
#3
Indianapolis, IN 46260
Phone (317) 338-2300

2001 W 86th St
Unit 3RD
Indianapolis, IN 46260
Phone (317) 338-5346

Ownership & related parties

All disclosed owners & managing parties 6

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Daniel Woloszyn Individual Corporate OfficerCeo Feb 1, 2013
W-2 Managing Employee Feb 1, 2013
Indiana University Health Inc Organization, Indianapolis, IN Non-profit Other Feb 10, 1992 51%
Daniel F Evans Individual Other Nov 1, 2002
Rehabilitation Hospital of Indiana Inc Organization, Indianapolis, IN Non-profit 5% Or Greater Direct Ownership Interest Feb 10, 1992 100%
Marjorie Basey Individual Corporate Officer Jan 1, 2015
Amanda Bushey Individual Corporate Director Sep 27, 2010

Owners & managing parties with NPI records 21

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 21

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.

Affiliated clinicians 13

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1164153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423612800000",
    "number": "1255406369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4141 SHORE DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462542607",
            "telephone_number": "317-329-2000",
            "fax_number": "317-329-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4141 SHORE DR",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462542607",
            "telephone_number": "317-329-2000",
            "fax_number": "317-329-2600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REHABILITATION HOSPITAL OF INDIANA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-22",
        "last_updated": "2015-02-11",
        "status": "A",
        "authorized_official_last_name": "SAFFA",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_title_or_position": "DIR ACCT FINANCE",
        "authorized_official_telephone_number": "317-329-2000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "283X00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Hospital",
            "state": "IN",
            "license": "06-005971-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MMG",
            "identifier": "68192",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PIN",
            "identifier": "000000097990",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100274620A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "I014220",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SIHO",
            "identifier": "016661P",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.