NPIMap

Organization Active NPI

Medical Rehabilitation Group PC

  • Physical Medicine & Rehabilitation Physician
  • Grand Blanc, MI
National Provider Identifier
1700833563
Registry record updated Feb 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
5101011645 Issued in MI
Legal business name
MEDICAL REHABILITATION GROUP PC
Practice address
4632 Genesys Pkwy
Grand Blanc, MI 48439-8067
Phone
(810) 606-7181
Fax
(810) 606-5803
NPI assigned
May 27, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mr. Richard Jay Kovan, M.D.NPI 1891751509
Title
Physician
Phone
(810) 606-7181

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Practitioners 10

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040331000816 MI Part B Supplier - Clinic/Group Practice 2860484888 Receives reassigned benefits from 6 practitioners
Practice locations: Grand Blanc, MI

National Provider Directory

National Provider Directory

Locations

4632 Genesys Pkwy
Grand Blanc, MI 48439
Phone (810) 606-7181

Specialties & licenses 4

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208100000X 4301055356 MI
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208100000X 5101011645 MI Primary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208100000X 4301072856 MI
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208100000X 5101011977 MI

Addresses

NPPES NPI Registry

Primary practice location

4632 Genesys Pkwy
Grand Blanc, MI 48439-8067

Mailing address

4632 Genesys Pkwy
Grand Blanc, MI 48439-8067
Phone (810) 606-7181

Other identifiers 4

NPPES NPI Registry
IdentifierTypeStateIssuer
4510933MedicaidMI
3477280MedicaidMI
2984537MedicaidMI
4614885MedicaidMI

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 4, 2009.

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1233705600000",
    "number": "1700833563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4632 GENESYS PKWY",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484398067",
            "telephone_number": "810-606-7181",
            "fax_number": "810-606-5803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4632 GENESYS PKWY",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484398067",
            "telephone_number": "810-606-7181",
            "fax_number": "810-606-5803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL REHABILITATION GROUP PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2009-02-04",
        "status": "A",
        "authorized_official_last_name": "KOVAN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "810-606-7181",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": "4301055356",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": "5101011645",
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": "4301072856",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": "5101011977",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4510933",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3477280",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2984537",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4614885",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Blanc, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2009; 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.