NPIMap

Organization Active NPI

Active Life Health of Columbus LLC

  • Physical Medicine & Rehabilitation Physician
  • Dublin, OH
National Provider Identifier
1720603418
Registry record updated Jun 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
ACTIVE LIFE HEALTH OF COLUMBUS LLC
Practice address
6325 Emerald Pkwy Ste 2B
Dublin, OH 43016-3241
Phone
(614) 504-0741
NPI assigned
Jun 9, 2020
Last updated
Jun 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2020

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

Authorized official

Name
John J Rush, MDNPI 1851337281
Title
Chairman & Chief Executive Officer
Phone
(301) 928-1697

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X Primary

Addresses

Primary practice location

6325 Emerald Pkwy Ste 2B
Dublin, OH 43016-3241

Mailing address

6325 Emerald Pkwy Ste 2B
Dublin, OH 43016-3241
Phone (614) 504-0741

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200710002275 OH Part B Supplier - Clinic/Group Practice 9234552142 Receives reassigned benefits from 11 practitioners
Practice locations: Dublin, OH

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Active Life Health of Columbus LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6325 Emerald Pkwy
Dublin, OH 43016
Phone (216) 409-2956

6325 Emerald Pkwy
Ste 2B
Dublin, OH 43016
Phone (614) 333-5366

6325 Emerald Pkwy
Unit 1A
Dublin, OH 43016
Phone (614) 504-0741

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1591660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591660800000",
    "number": "1720603418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6325 EMERALD PKWY STE 2B",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430163241",
            "telephone_number": "614-504-0741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6325 EMERALD PKWY STE 2B",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430163241",
            "telephone_number": "614-504-0741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE LIFE HEALTH OF COLUMBUS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-09",
        "last_updated": "2020-06-09",
        "certification_date": "2020-06-09",
        "status": "A",
        "authorized_official_last_name": "RUSH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHAIRMAN & CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "301-928-1697",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dublin, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 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.