NPIMap

Organization Active NPI

Tri-Vista Rehab, Inc

Doing business as TriVista Rehab at Riverbirch Residence

  • Rehabilitation Clinic/Center
  • Plantersville, MS
National Provider Identifier
1386240893
Registry record updated Dec 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
TRI-VISTA REHAB, INC
Doing business as
TriVista Rehab at Riverbirch Residence
Practice address
2554 Main St
Plantersville, MS 38862-7908
Phone
(662) 407-0301
Fax
(662) 842-7915
NPI assigned
Dec 9, 2020
Last updated
Dec 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2020

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

Authorized official

Name
Kevin Boutin, OTRNPI 1780740456
Title
President
Phone
(662) 840-0535

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

2554 Main St
Plantersville, MS 38862-7908

Mailing address

PO Box 3592
Tupelo, MS 38803-3592
Phone (662) 407-0301

Other names 1

  • TriVista Rehab at Riverbirch Residence Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201228002620 MS Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 0345390308 Practice locations: Plantersville, MS

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Shiloh Ridge Athletic Club8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

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": "1607472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607472000000",
    "number": "1386240893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3592",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388033592",
            "telephone_number": "662-407-0301",
            "fax_number": "662-842-7915"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2554 MAIN ST",
            "city": "PLANTERSVILLE",
            "state": "MS",
            "postal_code": "388627908",
            "telephone_number": "662-407-0301",
            "fax_number": "662-842-7915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRI-VISTA REHAB, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-09",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A",
        "authorized_official_last_name": "BOUTIN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-840-0535",
        "authorized_official_credential": "OTR"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "TriVista Rehab at Riverbirch Residence",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Plantersville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 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.