NPIMap

Organization Active NPI

Serc Rehabilitation Partners, LLC

Doing business as Serc

  • Physical Therapist
  • Belton, MO
National Provider Identifier
1760745244
Registry record updated Dec 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
SERC REHABILITATION PARTNERS, LLC
Doing business as
Serc
Practice address
17134 Bel Ray PL
Belton, MO 64012-5331
Phone
(816) 226-4011
Fax
(816) 524-6115
NPI assigned
Jun 20, 2012
Last updated
Dec 9, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2014

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

Authorized official

Name
Kevin Johanneson
Title
Manager
Phone
(423) 238-8923

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary
Occupational Therapist 225X00000X
Ergonomics Occupational Therapist 225XE1200X
Hand Occupational Therapist 225XH1200X

Addresses

Primary practice location

17134 Bel Ray PL
Belton, MO 64012-5331

Mailing address

8823 Production LN
Ooltewah, TN 37363-6511
Phone (423) 238-7217

Other identifiers 2

IdentifierTypeStateIssuer
MA4370OtherMOMEDICARE PTAN
KA2868OtherKSMEDICARE PTAN

Other names 1

  • SERC Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, KS, AR3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20130304000500 MO Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9830344563 Receives reassigned benefits from 207 practitioners
18 other NPIs on this enrollment
Practice locations: Lake Ozark, MO; Lees Summit, MO; Mount Vernon, MO; Kansas City, MO; Oak Grove, MO; Odessa, MO; Platte City, MO; Pleasant Hill, MO…
O20130517000516 KS Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9830344563 Receives reassigned benefits from 107 practitioners
Practice locations: Atchison, KS; Wichita, KS; Topeka, KS; Spring Hill, KS; Shawnee, KS; Overland Park, KS; Ottawa, KS; Eudora, KS…
O20150220000556 AR Part B Supplier - Physical/Occupational Therapy Group in Private Practice 9830344563 Receives reassigned benefits from 61 practitioners
1 other NPI on this enrollment
Practice locations: Tontitown, AR; Springdale, AR; Rogers, AR; Pea Ridge, AR; Maumelle, AR; Little Rock, AR; Hot Springs, AR; Fayetteville, AR…

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 19

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

View all 19

National Provider Directory

National Provider Directory

Locations

1733 Forest Hills Blvd
Bella Vista, AR 72715
Phone (479) 582-4646

222 Wellington Hills Rd
Little Rock, AR 72211
Phone (501) 604-8088

222 Wellington Hills Rd
#100
Little Rock, AR 72211
Phone (501) 604-8088

1328 Slack St
Pea Ridge, AR 72751

1331 E Henri de Tonti Blvd
Tontitown, AR 72762

2108 W 27th St
Ste K
Lawrence, KS 66047
Phone (785) 856-0160

650 Congressional Dr
Ste D
Lawrence, KS 66049
Phone (785) 588-4170

6640 Johnson Dr
Mission, KS 66202
Phone (913) 384-5600

12755 S Mur Len Rd
Ste B1
Olathe, KS 66062
Phone (913) 782-7734

11120 Antioch Rd
Ste 17
Overland Park, KS 66210
Phone (913) 451-7372

13847 W 63rd St
#2
Shawnee, KS 66216
Phone (913) 962-7774

13847 W 63rd St
Ste 2
Shawnee, KS 66216
Phone (913) 962-7770

1707 SE 29th St
Ste 300
Topeka, KS 66605
Phone (785) 266-4600

2021 SW Gage Blvd
Topeka, KS 66604
Phone (785) 273-7700

3405 NW Hunters Ridge Ter
#30
Topeka, KS 66618

4035 SW 10th Ave
Topeka, KS 66604
Phone (785) 273-7700

6749 SW 29th St
Ste B1
Topeka, KS 66614

1225 SW State Route 7
Blue Springs, MO 64014
Phone (816) 295-2051

11902 Blue Ridge Ext
#11906B
Grandview, MO 64030

11902 Blue Ridge Ext
Ste B
Grandview, MO 64030

815 Westchester Ave
Harrisonville, MO 64701
Phone (816) 331-9111

1227 E 32nd St
Ste 7
Joplin, MO 64804
Phone (417) 624-7400

3355 Main St
Kansas City, MO 64111
Phone (816) 399-0806

908 Baltimore Ave
Ste 101
Kansas City, MO 64105
Phone (816) 283-8343

9760 N Ash Ave
Kansas City, MO 64157
Phone (816) 792-0775

Practitioners & affiliated clinicians

Practitioners 338

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 338

NPI Registry JSON

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

{
    "created_epoch": "1340150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1418083200000",
    "number": "1760745244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8823 PRODUCTION LN",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373636511",
            "telephone_number": "423-238-7217",
            "fax_number": "423-238-3473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17134 BEL RAY PL",
            "city": "BELTON",
            "state": "MO",
            "postal_code": "640125331",
            "telephone_number": "816-226-4011",
            "fax_number": "816-524-6115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SERC REHABILITATION PARTNERS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-20",
        "last_updated": "2014-12-09",
        "status": "A",
        "authorized_official_last_name": "JOHANNESON",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "423-238-8923"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XE1200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Ergonomics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XH1200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Hand",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "MA4370",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "KA2868",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SERC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Belton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2014; 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.