NPIMap

Organization Active NPI

Elite Physical Medicine and Rehabilitation LLC

  • Interventional Pain Medicine Physician
  • Mason, OH
National Provider Identifier
1669963021
Registry record updated Jan 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
ELITE PHYSICAL MEDICINE AND REHABILITATION LLC
Practice address
6213 Snider Rd Ste a
Mason, OH 45040-2793
Phone
(513) 486-3744
NPI assigned
May 22, 2018
Last updated
Jan 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 10, 2023

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

Authorized official

Name
David Segraves
Title
Owner
Phone
(513) 486-3744

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU
Chiropractor 111N00000X NU
Physical Medicine & Rehabilitation Physician 208100000X NU
Interventional Pain Medicine Physician 208VP0014X NU Primary

Addresses

Primary practice location

6213 Snider Rd Ste a
Mason, OH 45040-2793

Mailing address

6213 Snider Rd Ste a
Mason, OH 45040-2643
Phone (513) 486-3744

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200402001601 OH Part B Supplier - Clinic/Group Practice 3375972979 Receives reassigned benefits from 9 practitioners
Practice locations: Mason, OH
O20200414003602 OH DME Supplier - Physician - General Practice 3375972979 Practice locations: Mason, OH

National Provider Directory

National Provider Directory

Locations

401 W Eads Pkwy
#320
Lawrenceburg, IN 47025
Phone (513) 486-3744

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1526947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673308800000",
    "number": "1669963021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6213 SNIDER RD STE A",
            "city": "MASON",
            "state": "OH",
            "postal_code": "450402643",
            "telephone_number": "513-486-3744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6213 SNIDER RD STE A",
            "city": "MASON",
            "state": "OH",
            "postal_code": "450402793",
            "telephone_number": "513-486-3744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE PHYSICAL MEDICINE AND REHABILITATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-22",
        "last_updated": "2023-01-10",
        "certification_date": "2023-01-10",
        "status": "A",
        "authorized_official_last_name": "SEGRAVES",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "513-486-3744"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mason, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2023; 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.