NPIMap

Organization Active NPI

Farmington Sports and Rehabilitation Joint Venture

  • Rehabilitation Clinic/Center
  • Farmington, MO
National Provider Identifier
1568513646
Registry record updated Jan 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
FARMINGTON SPORTS AND REHABILITATION JOINT VENTURE
Practice address
602 Maple Valley Dr
Farmington, MO 63640-1976
Phone
(573) 756-2999
Fax
(573) 756-6195
NPI assigned
Jan 15, 2007
Last updated
Jan 6, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2020

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

Authorized official

Name
Ms. Catherine A DulleNPI 1447630629
Title
President of Partnership
Phone
(573) 506-8800

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

602 Maple Valley Dr
Farmington, MO 63640-1976

Mailing address

602 Maple Valley Dr
Farmington, MO 63640-1976
Phone (573) 756-2999

Other identifiers 1

IdentifierTypeStateIssuer
578631509MedicaidMO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190826003937 MO Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 8325174105 Practice locations: Farmington, MO; Desloge, MO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1568513646. Details of each certification follow.

  • CCN 266680 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 266680

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
FARMINGTON SPORTS AND REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Aug 5, 2019
Last certification
Jul 29, 2022
Ownership / control type
Proprietary
Facility address
602 Maple Valley Drive
Farmington, MO 63640

National Provider Directory

National Provider Directory

Locations

1136 N Desloge Dr
Ste F
Desloge, MO 63601
Phone (573) 756-2999

602 Maple Valley Dr
Farmington, MO 63640
Phone (573) 756-2999

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1168819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578268800000",
    "number": "1568513646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 MAPLE VALLEY DR",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636401976",
            "telephone_number": "573-756-2999",
            "fax_number": "573-756-6195"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 MAPLE VALLEY DR",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636401976",
            "telephone_number": "573-756-2999",
            "fax_number": "573-756-6195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FARMINGTON SPORTS AND REHABILITATION JOINT VENTURE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-15",
        "last_updated": "2020-01-06",
        "certification_date": "2020-01-06",
        "status": "A",
        "authorized_official_last_name": "DULLE",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT OF PARTNERSHIP",
        "authorized_official_telephone_number": "573-506-8800",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "578631509",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, MO

Sources for this page

Verify at the official NPI Registry.