NPIMap

Organization Active NPI

Marquette Rehabilitation & Sports Medicine Center

  • Physical Therapy Clinic/Center
  • Marquette, MI
National Provider Identifier
1376771287
Registry record updated Jan 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
5501013363 Issued in MI
Legal business name
MARQUETTE REHABILITATION & SPORTS MEDICINE CENTER
Practice address
1455 W Fair Ave
Marquette, MI 49855-2654
Phone
(906) 226-0574
Fax
(888) 347-1135
NPI assigned
Jun 30, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2022

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

Authorized official

Name
Dr. Kiplin M Hartman, DPTNPI 1861699878
Title
Owner/Physical Therapist
Phone
(906) 362-0013

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 Therapy Clinic/Center 261QP2000X 5501013363 MI Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

1455 W Fair Ave
Marquette, MI 49855-2654

Mailing address

1455 W Fair Ave
Marquette, MI 49855-2654
Phone (906) 226-0574

Other identifiers 2

IdentifierTypeStateIssuer
DT4588OtherMIRAILROAD MEDICARE PTAN
1376771287MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130112000046 MI Part B Supplier - Physical/Occupational Therapy Group in Private Practice 0941351761 Receives reassigned benefits from 17 practitioners
Practice locations: Marquette, MI; Gwinn, MI

National Provider Directory

National Provider Directory

Locations

48 E Stephenson Ave
Gwinn, MI 49841
Phone (906) 226-0574

128 N 3rd St
Marquette, MI 49855
Phone (906) 273-0757

1455 W Fair Ave
Marquette, MI 49855
Phone (906) 226-0574

1121 W Ridge St
Marquette, MI 49855
Phone (906) 226-0574

1205 W Fair Ave
Marquette, MI 49855
Phone (906) 362-0013

Practitioners & affiliated clinicians

Practitioners 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1246320000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642464000000",
    "number": "1376771287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1455 W FAIR AVE",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498552654",
            "telephone_number": "906-226-0574",
            "fax_number": "888-347-1135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1455 W FAIR AVE",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498552654",
            "telephone_number": "906-226-0574",
            "fax_number": "888-347-1135"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARQUETTE REHABILITATION & SPORTS MEDICINE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-30",
        "last_updated": "2022-01-18",
        "certification_date": "2022-01-18",
        "status": "A",
        "authorized_official_last_name": "HARTMAN",
        "authorized_official_first_name": "KIPLIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "906-362-0013",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DPT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "MI",
            "license": "5501013363",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "DT4588",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1376771287",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marquette, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 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.