NPIMap

Organization Active NPI

Maxicare Therapy and Wellness of Nevada

  • Physical Therapist
  • Las Vegas, NV
National Provider Identifier
1376175786
Registry record updated Jan 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
MAXICARE THERAPY AND WELLNESS OF NEVADA
Doing business as
Maxicare Therapy and Wellness of Nevada
Practice address
4510 S Eastern Ave Ste 5
Las Vegas, NV 89119-6118
Phone
(702) 381-6053
Fax
(702) 987-0199
NPI assigned
Feb 4, 2020
Last updated
Jan 19, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2022

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

Authorized official

Name
Jose Gorgonia Tiu Jr., DPTNPI 1952602674
Title
Physical Therapist
Phone
(702) 381-6053

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary
Cardiopulmonary Physical Therapist 2251C2600X
Orthopedic Physical Therapist 2251X0800X
Pulmonary Rehabilitation Certified Respiratory Therapist 2278P1005X
Physical Rehabilitation Occupational Therapist 225XP0019X

Addresses

Primary practice location

4510 S Eastern Ave Ste 5
Las Vegas, NV 89119-6118

Mailing address

4510 S Eastern Ave Ste 5
Las Vegas, NV 89119-6118
Phone (702) 381-6053

Other practice location 1

4510 S Eastern Ave Ste 9
Las Vegas, NV 89119-6118
Phone (702) 381-6053

Other names 1

  • Maxicare Therapy and Wellness of Nevada Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210506002238 NV Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4183033954 Receives reassigned benefits from 9 practitioners
Practice locations: Las Vegas, NV

National Provider Directory

National Provider Directory

Locations

4510 S Eastern Ave
Ste 5
Las Vegas, NV 89119
Phone (702) 381-6053

Practitioners & affiliated clinicians

Practitioners 9

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": "1580774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642550400000",
    "number": "1376175786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4510 S EASTERN AVE STE 5",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891196118",
            "telephone_number": "702-381-6053",
            "fax_number": "702-987-0199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4510 S EASTERN AVE STE 5",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891196118",
            "telephone_number": "702-381-6053",
            "fax_number": "702-987-0199"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4510 S Eastern Ave Ste 9",
            "address_purpose": "LOCATION",
            "city": "Las Vegas",
            "state": "NV",
            "postal_code": "891196118",
            "country_code": "US",
            "telephone_number": "702-381-6053",
            "fax_number": "702-987-0199",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MAXICARE THERAPY AND WELLNESS OF NEVADA",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-04",
        "last_updated": "2022-01-19",
        "certification_date": "2022-01-19",
        "status": "A",
        "authorized_official_last_name": "TIU",
        "authorized_official_first_name": "JOSE",
        "authorized_official_middle_name": "GORGONIA",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "702-381-6053",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2251C2600X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Cardiopulmonary",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2278P1005X",
            "taxonomy_group": "",
            "desc": "Respiratory Therapist, Certified, Pulmonary Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0019X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Physical Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maxicare Therapy and Wellness of Nevada",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Maxicare Therapy and Wellness of Nevada",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2022; 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.