NPIMap

Organization Active NPI

Reconnect Wellness Bruce LLC

  • Preferred Provider Organization
  • Bruce, MS
National Provider Identifier
1396286456
Registry record updated Mar 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
Legal business name
RECONNECT WELLNESS BRUCE LLC
Practice address
131 Public Square
Bruce, MS 38915
Phone
(166) 298-2292
NPI assigned
Mar 9, 2017
Last updated
Mar 9, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2017

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

Authorized official

Name
Douglas M Wright Jr.
Title
Managing Member Reconnect Outpatien
Phone
(662) 680-3148

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X Primary

Addresses

Primary practice location

131 Public Square
Bruce, MS 38915

Mailing address

PO Box 3667
Tupelo, MS 38803-3667

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396286456. Details of each certification follow.

  • CCN 256614 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 256614

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
RECONNECT THERAPY AND WELLNESS ( BRUCE)
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Sep 27, 2017
Last certification
Sep 4, 2024
Ownership / control type
Proprietary
Facility address
131 Public Square
Bruce, MS 38915

National Provider Directory

National Provider Directory

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": "1489017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489017600000",
    "number": "1396286456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3667",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388033667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 PUBLIC SQUARE",
            "city": "BRUCE",
            "state": "MS",
            "postal_code": "38915",
            "telephone_number": "166-298-2292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RECONNECT WELLNESS BRUCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-09",
        "last_updated": "2017-03-09",
        "status": "A",
        "authorized_official_last_name": "WRIGHT",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MANAGING MEMBER RECONNECT OUTPATIEN",
        "authorized_official_telephone_number": "16626803148",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bruce, MS

Sources for this page

Verify at the official NPI Registry.