NPIMap

Organization Active NPI

Elevate Physical Therapy & Pain Center Inc

  • Physical Therapist
  • Brevard, NC
National Provider Identifier
1336492297
Registry record updated Sep 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
7217 Issued in NC
Legal business name
ELEVATE PHYSICAL THERAPY & PAIN CENTER INC
Practice address
4 Market St
Suite 4103
Brevard, NC 28712-5635
Phone
(828) 877-2110
NPI assigned
Oct 16, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2020

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

Authorized official

Name
Mark Herbert Blakely, DPT, OCSNPI 1922192947
Title
Owner/Physical Therapist
Phone
(828) 342-7358

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 7217 NC Primary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X 8721 NC

Addresses

Primary practice location

4 Market St
Suite 4103
Brevard, NC 28712-5635

Mailing address

4 Market St Ste 4103
Brevard, NC 28712-5636
Phone (828) 342-7358

Other identifiers 6

IdentifierTypeStateIssuer
078RGOtherNCBLUE CROSS BLUE SHIELD
078RCOtherNCBLUE CROSS BLUE SHIELD
7211277MedicaidNC
B8364OtherNCMEDCOST
B8363OtherNCMEDCOST
7211281MedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130107000040 NC Part B Supplier - Clinic/Group Practice 6608029384 Receives reassigned benefits from 8 practitioners
Practice locations: Brevard, NC; Franklin, NC

National Provider Directory

National Provider Directory

Locations

4 Market St
Ste 4103
Brevard, NC 28712
Phone (828) 342-7358

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1350345600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601424000000",
    "number": "1336492297",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 MARKET ST STE 4103",
            "city": "BREVARD",
            "state": "NC",
            "postal_code": "287125636",
            "telephone_number": "828-342-7358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 MARKET ST",
            "address_2": "SUITE 4103",
            "city": "BREVARD",
            "state": "NC",
            "postal_code": "287125635",
            "telephone_number": "828-877-2110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELEVATE PHYSICAL THERAPY & PAIN CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-16",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A",
        "authorized_official_last_name": "BLAKELY",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "HERBERT",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "828-342-7358",
        "authorized_official_credential": "DPT, OCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "7217",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "8721",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "078RG",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "078RC",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7211277",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "B8364",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST",
            "identifier": "B8363",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7211281",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Brevard, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 30, 2020; 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.