NPIMap

Organization Active NPI

Serc Rehabilitation Partners, LLC

Doing business as Serc

  • Physical Therapy Clinic/Center
  • Riverside, MO
National Provider Identifier
1700140258
Registry record updated Sep 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
SERC REHABILITATION PARTNERS, LLC
Doing business as
Serc
Practice address
220 NW Platte Valley Dr
Riverside, MO 64150-9793
Phone
(816) 505-3422
Fax
(816) 505-3312
NPI assigned
Jun 29, 2012
Last updated
Sep 4, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2013

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

Authorized official

Name
Kiley Russell
Title
Manager
Phone
(423) 238-8923

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU
Physical Therapy Clinic/Center 261QP2000X NU Primary
Occupational Medicine Clinic/Center 261QX0100X NU

Addresses

Primary practice location

220 NW Platte Valley Dr
Riverside, MO 64150-9793

Mailing address

17134 Bel Ray PL
Belton, MO 64012-5331
Phone (816) 524-5130

Other names 1

  • SERC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130304000500 MO Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9830344563 Receives reassigned benefits from 207 practitioners
18 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lake Ozark, MO; Lees Summit, MO; Mount Vernon, MO; Kansas City, MO; Oak Grove, MO; Odessa, MO; Platte City, MO; Pleasant Hill, MO…

Other NPIs on the same Medicare enrollment 18

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 18

National Provider Directory

National Provider Directory
Tax ID family
Serc Rebabilitation Partners LLC82 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

220 NW Platte Valley Dr
Riverside, MO 64150
Phone (816) 505-3422

Practitioners & affiliated clinicians

Practitioners 1

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": "1340928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1378252800000",
    "number": "1700140258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17134 BEL RAY PL",
            "city": "BELTON",
            "state": "MO",
            "postal_code": "640125331",
            "telephone_number": "816-524-5130",
            "fax_number": "816-524-6115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 NW PLATTE VALLEY DR",
            "city": "RIVERSIDE",
            "state": "MO",
            "postal_code": "641509793",
            "telephone_number": "816-505-3422",
            "fax_number": "816-505-3312"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERC REHABILITATION PARTNERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-29",
        "last_updated": "2013-09-04",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "KILEY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "423-238-8923"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SERC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Riverside, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2013; 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.