NPIMap

Organization Active NPI

Novacare Outpatient Rehabilitation East, Inc.

Doing business as NovaCare Rehabilitation

  • Rehabilitation Clinic/Center
  • Woodbury, MN
National Provider Identifier
1730720509
Registry record updated Aug 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
NOVACARE OUTPATIENT REHABILITATION EAST, INC.
Doing business as
NovaCare Rehabilitation
Practice address
6025 Lake Rd Ste 200
Woodbury, MN 55125-1710
Phone
(612) 439-4222
Fax
(651) 730-1979
NPI assigned
Oct 3, 2019
Last updated
Aug 20, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
SELECT MEDICALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 20, 2020

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

Authorized official

Name
Michael Tarvin
Title
Vice President
Phone
(717) 972-1100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X NU
Rehabilitation Clinic/Center 261QR0400X NU Primary

Addresses

Primary practice location

6025 Lake Rd Ste 200
Woodbury, MN 55125-1710

Mailing address

4714 Gettysburg Rd
Mechanicsburg, PA 17055-4325

Other names 1

  • NovaCare Rehabilitation Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121228000194 MN Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3678480290 Receives reassigned benefits from 78 practitioners
10 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Coon Rapids, MN; Maple Grove, MN; Richfield, MN; Saint Paul, MN

Other NPIs on the same Medicare enrollment 10

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

National Provider Directory

National Provider Directory
Part of
Select Medical Corporation

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": "1570060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597881600000",
    "number": "1730720509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4714 GETTYSBURG RD",
            "city": "MECHANICSBURG",
            "state": "PA",
            "postal_code": "170554325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6025 LAKE RD STE 200",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551251710",
            "telephone_number": "612-439-4222",
            "fax_number": "651-730-1979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVACARE OUTPATIENT REHABILITATION EAST, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SELECT MEDICAL",
        "enumeration_date": "2019-10-03",
        "last_updated": "2020-08-20",
        "certification_date": "2020-08-20",
        "status": "A",
        "authorized_official_last_name": "TARVIN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "717-972-1100"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NovaCare Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NovaCare Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Woodbury, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 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.