BHSM Rehabilitation, LLC
Organization Active NPI Rehabilitation Hospital · Phoenix, AZ
NPI 1851921571 · NPPES record last updated Sep 10, 2025
Key facts
- NPI
- 1851921571
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rehabilitation Hospital 283X00000X
- Legal business name
- BHSM REHABILITATION, LLC
- Practice address
- 775 E Willetta St
Phoenix, AZ 85006-2723 - Phone
- (717) 972-1100
- NPI assigned
- Jan 22, 2020
- Organization subpart
- No
Authorized official
- Name
- John Duggan
- Title
- VP
- Phone
- (717) 972-1100
Owners & managing parties with NPI records 13
Corporate family (same tax ID) 45
Member of 4
Facilities with the same owner 188
Practitioners 10
-
Christopher P Barnes, M.D.
-
David Lee Jung, M.D.
-
Ronald Stephen Quang, M.D.
Affiliated clinicians 10
-
Christopher P Barnes, M.D.
-
Kyle Fjerstad, P.A.C.
-
David Lee Jung, M.D.
-
Harrison Massey, MD
Medicare Care Compare: Inpatient rehabilitation facility
- Listed as
- Banner Rehabilitation Hospital-West
- Ownership
- For profit
- Certified
- Sep 25, 2020
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 03D2183406 | BHSM Rehabilitation, LLC | Certificate of waiver | May 4, 2028 |
| 03D2183407 | BHSM Rehabilitation, LLC | Certificate of waiver | May 4, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AZ
Hospital certification: CCN 033042
- Legal name
- BHSM REHABILITATION LLC
- Doing business as
- BANNER REHABILITATION HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Rehabilitation
- Participating since
- Sep 25, 2020
- Last certification
- Sep 25, 2020
- Beds
- 56
- Ownership / control type
- Private (for profit)
- Organization structure
- LLC · Proprietary
- Incorporated
- Nov 22, 2017 in DE
- Enrollment address
- 775 E Willetta St
Phoenix, AZ 85006-2723 - Hospital subgroups
- Rehabilitation
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Barlas Buyuktimkin |
Corporate Officer |
Mar 16, 2026 | |
| W-2 Managing Employee |
Mar 16, 2026 | ||
| Operational/Managerial Control |
Mar 16, 2026 | ||
| Select Medical Corporation |
5% Or Greater Indirect Ownership Interest | Aug 1, 2020 | 100% |
| Operational/Managerial Control | Aug 1, 2020 | 100% | |
| Thomas Mullin |
Corporate Officer | Jun 1, 2025 | |
| Young R an |
Corporate Officer |
Jun 1, 2025 | |
| W-2 Managing Employee |
Jun 1, 2025 | ||
| Operational/Managerial Control |
Jun 2, 2025 | ||
| John Saich |
Corporate Officer | Sep 5, 2025 | |
| Victoria Healthcare Inc |
5% Or Greater Indirect Ownership Interest | Aug 1, 2020 | 100% |
| Robert Breighner |
W-2 Managing Employee |
Sep 5, 2025 | |
| Select Specialty Hospitals Inc |
5% Or Greater Indirect Ownership Interest | Aug 1, 2020 | 100% |
| Thomas Rufrano |
Corporate Officer |
Aug 1, 2020 | |
| W-2 Managing Employee |
Aug 1, 2020 | ||
| Operational/Managerial Control |
Aug 1, 2020 | ||
| Michael Malatesta |
Corporate Officer | Jun 1, 2025 | |
| Robert Kido |
Corporate Officer | Sep 5, 2025 | |
| John Duggan |
Corporate Officer | Aug 1, 2020 | |
| Corporate Director | Sep 5, 2025 | ||
| Select Physical Therapy Holdings Inc |
5% Or Greater Direct Ownership Interest | Aug 1, 2020 | 51% |
| Banner Health |
5% Or Greater Direct Ownership Interest | Aug 1, 2020 | 49% |
| Scott Keen |
Corporate Officer |
Mar 17, 2025 | |
| W-2 Managing Employee |
Mar 17, 2025 | ||
| Operational/Managerial Control |
Mar 17, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200615002926 | AZ | Part a Provider - Hospital | 2062773138 | Practice locations: Mesa, AZ; Phoenix, AZ; Peoria, AZ |
National Provider Directory
- Tax ID family
- Banner Physical Therapy
Locations
12740 N Plaza del Rio Blvd
Peoria, AZ 85381
Phone (480) 581-3600
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Hospital | 283X00000X | Yes |
Addresses
Primary practice location
775 E Willetta St
Phoenix, AZ 85006-2723
Mailing address
4714 Gettysburg Rd
Attn Melanie Notario
Mechanicsburg, PA 17055
Phone (717) 972-1100
Other practice location 1
12740 N Plaza Del Rio Blvd
Peoria, AZ 85381-8100
Phone (717) 972-1100
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 033042 | Other | AZ | PTAN |
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.