NPIMap

Organization Active NPI

Southern Colorado Health & Rehab

Doing business as Momentum Physical Therapy of Pueblo

  • Physical Therapist
  • Pueblo, CO
National Provider Identifier
1295198067
Registry record updated Jun 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
SOUTHERN COLORADO HEALTH & REHAB
Doing business as
Momentum Physical Therapy of Pueblo
Practice address
1275 W Pueblo Blvd
Pueblo, CO 81004
Phone
(719) 542-0589
Fax
(719) 542-0119
NPI assigned
Mar 30, 2016
Last updated
Jun 6, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2018

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

Authorized official

Name
Mr. Blaine Stimac, MSPT
Title
Managing Partner
Phone
(406) 756-1128

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

1275 W Pueblo Blvd
Pueblo, CO 81004

Mailing address

PO Box 5718
Kalispell, MT 59903-5718
Phone (406) 756-0134

Other practice location 1

387 E Enterprise Dr Ste 160
Pueblo, CO 81007-8403
Phone (719) 924-8912

Other names 1

  • Momentum Physical Therapy of Pueblo Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160914000646 CO Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5799071924 Receives reassigned benefits from 15 practitioners
1 other NPI on this enrollment
Practice locations: Pueblo, CO

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Southern Colorado Health Rehab2 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.

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 24

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.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1459296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528243200000",
    "number": "1295198067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5718",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599035718",
            "telephone_number": "406-756-0134",
            "fax_number": "406-309-2579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 W PUEBLO BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "81004",
            "telephone_number": "719-542-0589",
            "fax_number": "719-542-0119"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "387 E Enterprise Dr Ste 160",
            "address_purpose": "LOCATION",
            "city": "Pueblo",
            "state": "CO",
            "postal_code": "810078403",
            "country_code": "US",
            "telephone_number": "719-924-8912",
            "fax_number": "719-696-9115",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SOUTHERN COLORADO HEALTH & REHAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-30",
        "last_updated": "2018-06-06",
        "status": "A",
        "authorized_official_last_name": "STIMAC",
        "authorized_official_first_name": "BLAINE",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "406-756-1128",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MSPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Momentum Physical Therapy of Pueblo",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2018; 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.