NPIMap

Organization Active NPI

Tri-Vista Rehab, Inc

  • Rehabilitation Clinic/Center
  • Richton, MS
National Provider Identifier
1265025522
Registry record updated Feb 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
TRI-VISTA REHAB, INC
Practice address
411 Oak St.
Richton, MS 39476
Phone
(662) 270-6486
Fax
(662) 842-7915
NPI assigned
Feb 18, 2021
Organization subpart
Yes
Parent organization
TRI-VISTA REHAB, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 18, 2021

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

Authorized official

Name
Kevin Boutin, OTRNPI 1780740456
Title
President
Phone
(662) 840-0535

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
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

411 Oak St.
Richton, MS 39476

Mailing address

PO Box 3592
Tupelo, MS 38803-3592
Phone (662) 840-0535

Other names 1

  • TriVista Rehab at Community Development Inc. Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210809001459 MS Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 0345390308 Practice locations: Richton, MS

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2228925Community Development Inc411 Oak St, Richton, MS 39476Certificate of waiverJul 1, 2027

National Provider Directory

National Provider Directory
Tax ID family
Trivista Rehab Inc8 organizations share this tax ID, including this one
Part of
Trivista Rehab Inc

Other organizations with this tax ID 7

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

Locations

3297 Highway 51 S
Senatobia, MS 38668
Phone (662) 366-6923

Practitioners & affiliated clinicians

Practitioners 45

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1613606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613606400000",
    "number": "1265025522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3592",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388033592",
            "telephone_number": "662-840-0535",
            "fax_number": "662-842-7915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 OAK ST.",
            "city": "RICHTON",
            "state": "MS",
            "postal_code": "39476",
            "telephone_number": "662-270-6486",
            "fax_number": "662-842-7915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-VISTA REHAB, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRI-VISTA REHAB, INC",
        "enumeration_date": "2021-02-18",
        "last_updated": "2021-02-18",
        "certification_date": "2021-01-28",
        "status": "A",
        "authorized_official_last_name": "BOUTIN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-840-0535",
        "authorized_official_credential": "OTR"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TriVista Rehab at Community Development Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Richton, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.