Active NPI
SMR Banyan Tree, Inc.
- Physical Therapy Clinic/Center
- Macedonia, OH
National Provider Identifier
1649200049
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Clinic/Center
- Legal business name
- SMR BANYAN TREE, INC.
- Practice address
- 953 E Aurora Rd
Macedonia, OH 44056-1953 - Phone
- (330) 468-6070
- Fax
- (330) 468-6066
- NPI assigned
- Jul 3, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Jayne Fleck Pool
- Title
- Chief Compliance Officer
- Phone
- (469) 467-8705
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | Primary |
Addresses
Primary practice location
953 E Aurora Rd
Macedonia, OH 44056-1953
Mailing address
PO Box 1245
Indiana, PA 15701-5245
Phone (724) 465-3496
Other names 1
- Banyan Tree Rehabilitation
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051109000052 | OH | Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services | 2961420880 |
10 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Warren, OH |
Other NPIs on the same Medicare enrollment 10
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryLocations
953 E Aurora Rd
Macedonia, OH 44056
Phone (330) 468-6070
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151884800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1277683200000",
"number": "1649200049",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1245",
"city": "INDIANA",
"state": "PA",
"postal_code": "157015245",
"telephone_number": "724-465-3496",
"fax_number": "215-413-4682"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "953 E AURORA RD",
"city": "MACEDONIA",
"state": "OH",
"postal_code": "440561953",
"telephone_number": "330-468-6070",
"fax_number": "330-468-6066"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SMR BANYAN TREE, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-03",
"last_updated": "2010-06-28",
"status": "A",
"authorized_official_last_name": "POOL",
"authorized_official_first_name": "JAYNE",
"authorized_official_middle_name": "FLECK",
"authorized_official_title_or_position": "CHIEF COMPLIANCE OFFICER",
"authorized_official_telephone_number": "469-467-8705",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Banyan Tree Rehabilitation",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Macedonia, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2010; 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.