NPIMap

Organization Active NPI

Medical Rehab Group LLP

  • Family Medicine Physician
  • Jonesboro, AR
National Provider Identifier
1669856704
Registry record updated Jul 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MEDICAL REHAB GROUP LLP
Practice address
1201 Fleming
Jonesboro, AR 72401
Phone
(870) 933-5174
Fax
(870) 933-5235
NPI assigned
Jul 18, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2015

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

Authorized official

Name
Dan Johnson, PHDNPI 1720004716
Title
Ceo
Phone
(870) 933-5174

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
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

1201 Fleming
Jonesboro, AR 72401

Mailing address

1201 Fleming
Jonesboro, AR 72401
Phone (870) 933-5174

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151124000846 AR Part B Supplier - Clinic/Group Practice 9133429152 Receives reassigned benefits from 14 practitioners
Practice locations: Jonesboro, AR

National Provider Directory

National Provider Directory

Locations

1201 Fleming Ave
Jonesboro, AR 72401
Phone (870) 932-0440

Practitioners & affiliated clinicians

Practitioners 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1437177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437177600000",
    "number": "1669856704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 FLEMING",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "72401",
            "telephone_number": "870-933-5174",
            "fax_number": "870-933-5235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 FLEMING",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "72401",
            "telephone_number": "870-933-5174",
            "fax_number": "870-933-5235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL REHAB GROUP LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-18",
        "last_updated": "2015-07-18",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-933-5174",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesboro, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2015; 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.