NPIMap

Organization Active NPI

Fundamental Therapies

  • Multi-Specialty Clinic/Center
  • Troy, MI
National Provider Identifier
1710553722
Registry record updated Sep 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
FUNDAMENTAL THERAPIES
Practice address
1950 E Wattles Rd Ste 108
Troy, MI 48085-5079
Phone
(248) 882-2797
NPI assigned
Jun 1, 2021
Last updated
Sep 8, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2021

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

Authorized official

Name
Kristina Frimmel, M.A. CCC-SLPNPI 1356826416
Title
Owner
Phone
(248) 606-0551

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 7

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Developmental Disabilities Clinic/Center 261QD1600X
Hearing and Speech Clinic/Center 261QH0700X
Multi-Specialty Clinic/Center 261QM1300X Primary
Physical Therapy Clinic/Center 261QP2000X
Occupational Therapist 225X00000X
Speech-Language Pathologist 235Z00000X

Addresses

Primary practice location

1950 E Wattles Rd Ste 108
Troy, MI 48085-5079

Mailing address

1950 E Wattles Rd Ste 108
Troy, MI 48085-5079
Phone (248) 606-0551

Other identifiers 5

IdentifierTypeStateIssuer
5201010755OtherMIOT STATE LICENSE
5501018572OtherMIPT STATE LICENSE
7101004463OtherMISLP STATE LICENSE
7101001116OtherMISLP STATE LICENSE
7101002637OtherMISLP STATE LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL kristina.frimmel@fundamentaltherapies.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210623003906 MI Part B Supplier - Clinic/Group Practice 4486055761 Receives reassigned benefits from 1 practitioner
Practice locations: Troy, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1622505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631059200000",
    "number": "1710553722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 E WATTLES RD STE 108",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480855079",
            "telephone_number": "248-606-0551",
            "fax_number": "248-928-5051"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 E WATTLES RD STE 108",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480855079",
            "telephone_number": "248-882-2797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FUNDAMENTAL THERAPIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-01",
        "last_updated": "2021-09-08",
        "certification_date": "2021-07-15",
        "status": "A",
        "authorized_official_last_name": "FRIMMEL",
        "authorized_official_first_name": "KRISTINA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "248-606-0551",
        "authorized_official_credential": "M.A. CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OT STATE LICENSE",
            "identifier": "5201010755",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT STATE LICENSE",
            "identifier": "5501018572",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SLP STATE LICENSE",
            "identifier": "7101004463",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SLP STATE LICENSE",
            "identifier": "7101001116",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SLP STATE LICENSE",
            "identifier": "7101002637",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "kristina.frimmel@fundamentaltherapies.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1950 E Wattles Rd Ste 108",
            "city": "Troy",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480855079",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Troy, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2021; 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.