NPIMap

Organization Active NPI

Sundance Rehabilitation LLC

  • Rehabilitation Clinic/Center
  • Sewell, NJ
National Provider Identifier
1750336053
Registry record updated May 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
License
N/A
Legal business name
SUNDANCE REHABILITATION LLC
Practice address
102B Kings Way W
Sewell, NJ 08080-2235
Phone
(856) 582-4500
NPI assigned
May 24, 2006
Last updated
May 3, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SUNDANCE REHABILITATION CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 3, 2023

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

Authorized official

Name
Carl Anthony Shrom
Title
Ceo
Phone
(215) 896-0422

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X N/A Primary

Addresses

Primary practice location

102B Kings Way W
Sewell, NJ 08080-2235

Mailing address

101 E State Street
C/O Amy Nunemaker
Kennett Square, PA 19348-3109
Phone (610) 925-4560

Other identifiers 11

IdentifierTypeStateIssuer
558970OtherAETNA US HEALTHCARE
2671079OtherCIGNA
1090113OtherHORIZON MERCY
46101OtherORTHONET
602638OtherKEYSTONE HP EAST
C4306OtherAMERIHEALTH ADMIN.
OK8006OtherHEALTHNET
SU343406OtherPENN BS
343406OtherBC/BS
QA9881OtherEMPIRE
744645OtherAMERIHEALTH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031104000310 NJ Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 7911815329 Practice locations: Sewell, NJ

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Sundance Rehabilitation Corp3 organizations share this tax ID, including this one
Part of
Sundance Rehabilitation Corp

Other organizations with this tax ID 2

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Member organizations 11

Organizations listed as members of this organization in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1148428800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683072000000",
    "number": "1750336053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 E STATE STREET",
            "address_2": "C/O AMY NUNEMAKER",
            "city": "KENNETT SQUARE",
            "state": "PA",
            "postal_code": "193483109",
            "telephone_number": "610-925-4560",
            "fax_number": "610-347-4147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102B KINGS WAY W",
            "city": "SEWELL",
            "state": "NJ",
            "postal_code": "080802235",
            "telephone_number": "856-582-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNDANCE REHABILITATION LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SUNDANCE REHABILITATION CORPORATION",
        "enumeration_date": "2006-05-24",
        "last_updated": "2023-05-03",
        "certification_date": "2023-05-03",
        "status": "A",
        "authorized_official_last_name": "SHROM",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "ANTHONY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "215-896-0422"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": "N/A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA US HEALTHCARE",
            "identifier": "558970",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2671079",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HORIZON MERCY",
            "identifier": "1090113",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ORTHONET",
            "identifier": "46101",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE HP EAST",
            "identifier": "602638",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH ADMIN.",
            "identifier": "C4306",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHNET",
            "identifier": "OK8006",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PENN BS",
            "identifier": "SU343406",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "343406",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE",
            "identifier": "QA9881",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIHEALTH",
            "identifier": "744645",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sewell, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2023; 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.