NPIMap

Organization Active NPI

Progressivehealth of Indiana, LLC

  • Rehabilitation Clinic/Center
  • Evansville, IN
National Provider Identifier
1659596328
Registry record updated Jan 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
PROGRESSIVEHEALTH OF INDIANA, LLC
Practice address
4521 Lincoln Ave
Evansville, IN 47714-0654
Phone
(812) 477-3422
Fax
(812) 475-2020
NPI assigned
Apr 16, 2007
Last updated
Jan 7, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2021

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

Authorized official

Name
Mr. Keith R Bersch
Title
Ceo
Phone
(812) 491-3856

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X
Rehabilitation Clinic/Center 261QR0400X Primary

Addresses

Primary practice location

4521 Lincoln Ave
Evansville, IN 47714-0654

Mailing address

150 N Rosenberger Ave
Evansville, IN 47712-6503
Phone (812) 491-3856

Other identifiers 1

IdentifierTypeStateIssuer
200873150BMedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131001000176 IN Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 6204937279 Practice locations: Evansville, IN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1659596328. Details of each certification follow.

  • CCN 156633 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 156633

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
PROGRESSIVE HEALTH OF INDIANA LLC
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Oct 26, 2007
Last certification
Oct 30, 2019
Ownership / control type
Proprietary
Facility address
4521 Lincoln Ave
Evansville, IN 47714

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1300 Professional Blvd
Evansville, IN 47714
Phone (812) 477-3422

4521 Lincoln Ave
Evansville, IN 47714
Phone (812) 477-3422

8700A N Kentucky Ave
Evansville, IN 47725
Phone (812) 437-2893

402 S Richland Creek Dr
Ste A
Princeton, IN 47670
Phone (812) 753-4549

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": "1176681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609977600000",
    "number": "1659596328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 N ROSENBERGER AVE",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477126503",
            "telephone_number": "812-491-3856",
            "fax_number": "812-491-1269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4521 LINCOLN AVE",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477140654",
            "telephone_number": "812-477-3422",
            "fax_number": "812-475-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVEHEALTH OF INDIANA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-16",
        "last_updated": "2021-01-07",
        "certification_date": "2021-01-07",
        "status": "A",
        "authorized_official_last_name": "BERSCH",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "812-491-3856",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200873150B",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.