NPIMap

Organization Active NPI

Defiance Hospital, Inc.

  • Physical Therapy Clinic/Center
  • Defiance, OH
National Provider Identifier
1629216684
Registry record updated Jun 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
1160 Issued in OH
Legal business name
DEFIANCE HOSPITAL, INC.
Practice address
851 S Clinton St
Atten: Cbo
Defiance, OH 43512-2770
Phone
(419) 824-7576
Fax
(419) 824-3460
NPI assigned
Jan 29, 2009
Organization subpart
Yes
Parent organization
PROMEDICA HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 22, 2012

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

Authorized official

Name
Ronald Wachsman
Title
Sr. VP
Phone
(419) 824-7576

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 1160 OH Primary

Addresses

Primary practice location

851 S Clinton St
Atten: Cbo
Defiance, OH 43512-2770

Mailing address

851 S Clinton St
Atten; Cbo
Defiance, OH 43512-2770
Phone (419) 824-7576

Other identifiers 1

IdentifierTypeStateIssuer
3065981MedicaidOH

Other names 1

  • DEFIANCE REHABILITATION SERVICES Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040322000150 OH Part B Supplier - Clinic/Group Practice 6305754557 Receives reassigned benefits from 11 practitioners
1 other NPI on this enrollment
Practice locations: Defiance, OH

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Defiance Hospital14 organizations share this tax ID, including this one
Part of
Promedica Health System

Other organizations with this tax ID 13

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

View all 13

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1233187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340323200000",
    "number": "1629216684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "851 S CLINTON ST",
            "address_2": "ATTEN; CBO",
            "city": "DEFIANCE",
            "state": "OH",
            "postal_code": "435122770",
            "telephone_number": "419-824-7576",
            "fax_number": "419-824-3460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "851 S CLINTON ST",
            "address_2": "ATTEN: CBO",
            "city": "DEFIANCE",
            "state": "OH",
            "postal_code": "435122770",
            "telephone_number": "419-824-7576",
            "fax_number": "419-824-3460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEFIANCE HOSPITAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PROMEDICA HEALTH SYSTEM",
        "enumeration_date": "2009-01-29",
        "last_updated": "2012-06-22",
        "status": "A",
        "authorized_official_last_name": "WACHSMAN",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "SR. VP",
        "authorized_official_telephone_number": "419-824-7576"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "OH",
            "license": "1160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3065981",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DEFIANCE REHABILITATION SERVICES",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Defiance, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2012; 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.