NPIMap

Organization Active NPI

Professional Rehabilitation Center

Doing business as Prorehab Center

  • Physical Therapist
  • Fargo, ND
National Provider Identifier
1326460528
Registry record updated Jan 8, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PROFESSIONAL REHABILITATION CENTER
Doing business as
Prorehab Center
Practice address
3105 Broadway N
Suite 7
Fargo, ND 58102-1454
Phone
(701) 451-9417
NPI assigned
Jan 8, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 8, 2014

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

Authorized official

Name
Tom BaumgartnerNPI 1215908876
Title
Owner/ President
Phone
(701) 451-9417

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X

Addresses

Primary practice location

3105 Broadway N
Suite 7
Fargo, ND 58102-1454

Mailing address

1711 Gold Dr S
Suite 120
Fargo, ND 58103-6416
Phone (701) 451-9417

Other names 1

  • Prorehab Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041006001028 ND Part B Supplier - Clinic/Group Practice 5193784080 Receives reassigned benefits from 13 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fargo, ND

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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": "1389139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389139200000",
    "number": "1326460528",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1711 GOLD DR S",
            "address_2": "SUITE 120",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581036416",
            "telephone_number": "701-451-9417",
            "fax_number": "701-298-0066"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3105 BROADWAY N",
            "address_2": "SUITE 7",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581021454",
            "telephone_number": "701-451-9417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROFESSIONAL REHABILITATION CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-08",
        "last_updated": "2014-01-08",
        "status": "A",
        "authorized_official_last_name": "BAUMGARTNER",
        "authorized_official_first_name": "TOM",
        "authorized_official_title_or_position": "OWNER/ PRESIDENT",
        "authorized_official_telephone_number": "701-451-9417"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prorehab Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2014; 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.