NPIMap

Organization Active NPI

Pulmonary Rehabilitation Associates

  • Pulmonary Disease Physician
  • Youngstown, OH
National Provider Identifier
1720205065
Registry record updated Jan 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
PULMONARY REHABILITATION ASSOCIATES
Practice address
925 Trailwood Dr
Youngstown, OH 44512-5008
Phone
(330) 758-7575
Fax
(330) 758-1833
NPI assigned
Apr 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2012

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

Authorized official

Name
Marijo D Shuntich
Title
Chief Operating Officer
Phone
(330) 758-7575

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0200X
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X Primary

Addresses

Primary practice location

925 Trailwood Dr
Youngstown, OH 44512-5008

Mailing address

925 Trailwood Dr
Youngstown, OH 44512-5008
Phone (330) 758-7575

Other identifiers 2

IdentifierTypeStateIssuer
607700OtherOHBLACK LUNG
0763973MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040630000885 OH Part B Supplier - Clinic/Group Practice 7719964485 Receives reassigned benefits from 12 practitioners
Practice locations: Youngstown, OH

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
36D0687648Pulmonary Rehabilitation Associates925 Trailwood Drive, Youngstown, OH 44512Certificate of waiverSep 30, 2027

National Provider Directory

National Provider Directory

Locations

925 Trailwood Dr
Youngstown, OH 44512
Phone (330) 758-7575

Practitioners & affiliated clinicians

Practitioners 12

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

NPI Registry JSON

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

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327363200000",
    "number": "1720205065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "925 TRAILWOOD DR",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445125008",
            "telephone_number": "330-758-7575",
            "fax_number": "330-758-1833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "925 TRAILWOOD DR",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445125008",
            "telephone_number": "330-758-7575",
            "fax_number": "330-758-1833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PULMONARY REHABILITATION ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2012-01-24",
        "status": "A",
        "authorized_official_last_name": "SHUNTICH",
        "authorized_official_first_name": "MARIJO",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "330-758-7575"
    },
    "taxonomies": [
        {
            "code": "207RC0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Critical Care Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLACK LUNG",
            "identifier": "607700",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0763973",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Youngstown, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.