NPIMap

Organization Active NPI

Big Blue Canopy LLC

  • Physical Therapist
  • Blue Ash, OH
National Provider Identifier
1548820772
Registry record updated Jun 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
BIG BLUE CANOPY LLC
Practice address
11230 Cornell Park Dr
Blue Ash, OH 45242-1825
Phone
(513) 880-6800
NPI assigned
Jun 19, 2019
Last updated
Jun 16, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2020

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

Authorized official

Name
Puja Gaitonde, PTNPI 1104180843
Title
Owner
Phone
(513) 880-6800

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
Physical Therapist 225100000X Primary

Addresses

Primary practice location

11230 Cornell Park Dr
Blue Ash, OH 45242-1825

Mailing address

11230 Cornell Park Dr
Blue Ash, OH 45242-1825
Phone (513) 880-6800

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200115001259 OH Part B Supplier - Clinic/Group Practice 4880029123 Receives reassigned benefits from 10 practitioners
Practice locations: Blue Ash, OH

National Provider Directory

National Provider Directory

Locations

11230 Cornell Park Dr
Blue Ash, OH 45242
Phone (513) 600-4706

Practitioners & affiliated clinicians

Practitioners 11

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": "1560902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592265600000",
    "number": "1548820772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11230 CORNELL PARK DR",
            "city": "BLUE ASH",
            "state": "OH",
            "postal_code": "452421825",
            "telephone_number": "513-880-6800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11230 CORNELL PARK DR",
            "city": "BLUE ASH",
            "state": "OH",
            "postal_code": "452421825",
            "telephone_number": "513-880-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BIG BLUE CANOPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-19",
        "last_updated": "2020-06-16",
        "certification_date": "2020-06-16",
        "status": "A",
        "authorized_official_last_name": "GAITONDE",
        "authorized_official_first_name": "PUJA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "513-880-6800",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blue Ash, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.