NPIMap

Organization Active NPI

Brooksby Village Inc

Doing business as Outpatient Rehabilitation Clinic at Brooksby

  • Rehabilitation Clinic/Center
  • Peabody, MA
National Provider Identifier
1396818688
Registry record updated Jan 15, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
License
48CI Issued in MA
Legal business name
BROOKSBY VILLAGE INC
Doing business as
Outpatient Rehabilitation Clinic at Brooksby
Practice address
302 Brooksby Village Drive
Attn: Rehabilitation Manager
Peabody, MA 01960-8563
Phone
(978) 536-2150
Fax
(410) 204-7237
NPI assigned
Nov 16, 2006
Last updated
Jan 15, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2015

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

Authorized official

Name
Christpher J Rathmann
Title
Assistant Treasurer
Phone
(410) 402-2390

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X 48CI MA Primary

Addresses

Primary practice location

302 Brooksby Village Drive
Attn: Rehabilitation Manager
Peabody, MA 01960-8563

Mailing address

100 Brooksby Village Dr
Attn: Executive Director
Peabody, MA 01960-1438
Phone (978) 536-2150

Other names 1

  • Outpatient Rehabilitation Clinic at Brooksby Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050502000399 MA Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 8820085954 Practice locations: Peabody, MA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1396818688. Details of each certification follow.

  • CCN 226539 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 226539

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
OUTPATIENT REHABILITATION CLINIC AT BROOKSBY
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Jun 28, 2006
Last certification
Feb 1, 2024
Ownership / control type
Voluntary Non-Profit Other Than Church
Facility address
302 Brooksby Village Drive
Peabody, MA 01960

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
BBV Outpatient Rehab3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Practitioners & affiliated clinicians

Practitioners 5

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": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421280000000",
    "number": "1396818688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 BROOKSBY VILLAGE DR",
            "address_2": "ATTN: EXECUTIVE DIRECTOR",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "019601438",
            "telephone_number": "978-536-2150",
            "fax_number": "410-204-7237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 BROOKSBY VILLAGE DRIVE",
            "address_2": "ATTN: REHABILITATION MANAGER",
            "city": "PEABODY",
            "state": "MA",
            "postal_code": "019608563",
            "telephone_number": "978-536-2150",
            "fax_number": "410-204-7237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKSBY VILLAGE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2015-01-15",
        "status": "A",
        "authorized_official_last_name": "RATHMANN",
        "authorized_official_first_name": "CHRISTPHER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "ASSISTANT TREASURER",
        "authorized_official_telephone_number": "410-402-2390"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "MA",
            "license": "48CI",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Outpatient Rehabilitation Clinic at Brooksby",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Peabody, MA

Sources for this page

Verify at the official NPI Registry.