NPIMap

Organization Active NPI

Esrc PLLC

Doing business as Eastside Sports Rehab

  • Physical Therapy Clinic/Center
  • Bellevue, WA
National Provider Identifier
1699796755
Registry record updated Jun 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
ESRC PLLC
Doing business as
Eastside Sports Rehab
Eastside Sports Rehabilitation Clinics
Practice address
11400 SE 6TH St Ste 105
Bellevue, WA 98004-6419
Phone
(425) 576-8180
Fax
(425) 746-2002
NPI assigned
Jul 22, 2006
Last updated
Jun 18, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2020

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

Authorized official

Name
Ms. Nicole Park
Title
Billing Manager
Phone
(425) 576-8180

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 225100000X
Physical Therapy Clinic/Center 261QP2000X Primary

Addresses

Primary practice location

11400 SE 6TH St Ste 105
Bellevue, WA 98004-6419

Mailing address

11400 SE 6TH St Ste 105
Bellevue, WA 98004-6419
Phone (425) 576-8180

Other names 2

  • Eastside Sports Rehab Doing business as
  • Eastside Sports Rehabilitation Clinics Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080311000365 WA Part B Supplier - Clinic/Group Practice 9638254907 Receives reassigned benefits from 10 practitioners
Practice locations: Bellevue, WA

National Provider Directory

National Provider Directory

Locations

11400 SE 6th St
Ste 105
Bellevue, WA 98004
Phone (425) 576-8180

10510 Northup Way
Ste 140
Kirkland, WA 98033
Phone (425) 576-8180

10510 Northup Way
#140
Kirkland, WA 98033
Phone (425) 576-8180

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592438400000",
    "number": "1699796755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11400 SE 6TH ST STE 105",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980046419",
            "telephone_number": "425-576-8180",
            "fax_number": "425-576-2002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11400 SE 6TH ST STE 105",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980046419",
            "telephone_number": "425-576-8180",
            "fax_number": "425-746-2002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESRC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2020-06-18",
        "certification_date": "2020-06-18",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "425-576-8180",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eastside Sports Rehab",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Eastside Sports Rehabilitation Clinics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2020; 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.