Active NPI
SMR Banyan Tree, Inc.
- Physical Therapist
- Hilliard, OH
National Provider Identifier
1679519003
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Legal business name
- SMR BANYAN TREE, INC.
- Practice address
- 5514 Nike Dr
Hilliard, OH 43026-9081 - Phone
- (614) 529-8733
- Fax
- (614) 529-6751
- NPI assigned
- Jun 22, 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
- Mr. Michael E Tarvin
- Title
- Vice President & Secretary
- Phone
- (717) 972-1100
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary | ||
| Rehabilitation Clinic/Center | 261QR0400X |
Addresses
Primary practice location
5514 Nike Dr
Hilliard, OH 43026-9081
Mailing address
4714 Gettysburg Road
Legal Dept
Mechanicsburg, PA 17055-4325
Phone (717) 972-1100
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
5514 Nike Dr
Hilliard, OH 43026
Phone (614) 529-8733
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1542758400000",
"number": "1679519003",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4714 GETTYSBURG ROAD",
"address_2": "LEGAL DEPT",
"city": "MECHANICSBURG",
"state": "PA",
"postal_code": "170554325",
"telephone_number": "717-972-1100"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5514 NIKE DR",
"city": "HILLIARD",
"state": "OH",
"postal_code": "430269081",
"telephone_number": "614-529-8733",
"fax_number": "614-529-6751"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SMR BANYAN TREE, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-06-22",
"last_updated": "2018-11-21",
"status": "A",
"authorized_official_last_name": "TARVIN",
"authorized_official_first_name": "MICHAEL",
"authorized_official_middle_name": "E",
"authorized_official_title_or_position": "VICE PRESIDENT & SECRETARY",
"authorized_official_telephone_number": "717-972-1100",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
},
{
"code": "261QR0400X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rehabilitation",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hilliard, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2018; 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.