NPIMap

Organization Active NPI

Sportpro LLC

  • Physical Therapy Clinic/Center
  • Mount Vernon, OH
National Provider Identifier
1881069789
Registry record updated Oct 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
PT013341 Issued in OH
Legal business name
SPORTPRO LLC
Practice address
781 Fairgrounds Rd
Mount Vernon, OH 43050-1165
Phone
(740) 263-7997
Fax
(740) 326-4743
NPI assigned
Dec 3, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2019

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

Authorized official

Name
Matthew Kelling, PTNPI 1235418278
Title
Physical Therapist
Phone
(815) 546-8865

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 Therapy Clinic/Center 261QP2000X PT013341 OH Primary

Addresses

Primary practice location

781 Fairgrounds Rd
Mount Vernon, OH 43050-1165

Mailing address

781 Fairgrounds Rd
Mount Vernon, OH 43050-1165
Phone (740) 263-7997

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160315000308 OH Part B Supplier - Physical/Occupational Therapy Group in Private Practice 6305142571 Receives reassigned benefits from 3 practitioners
Practice locations: Mount Vernon, OH

National Provider Directory

National Provider Directory

Locations

781 Fairgrounds Rd
Ste A
Mount Vernon, OH 43050
Phone (740) 263-7997

781 Fairgrounds Rd
Mount Vernon, OH 43050
Phone (740) 263-7997

7084 Newark Rd
Mount Vernon, OH 43050
Phone (740) 263-7997

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1449100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572220800000",
    "number": "1881069789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "781 FAIRGROUNDS RD",
            "city": "MOUNT VERNON",
            "state": "OH",
            "postal_code": "430501165",
            "telephone_number": "740-263-7997",
            "fax_number": "740-326-4743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "781 FAIRGROUNDS RD",
            "city": "MOUNT VERNON",
            "state": "OH",
            "postal_code": "430501165",
            "telephone_number": "740-263-7997",
            "fax_number": "740-326-4743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPORTPRO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-03",
        "last_updated": "2019-10-28",
        "status": "A",
        "authorized_official_last_name": "KELLING",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "815-546-8865",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "OH",
            "license": "PT013341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2019; 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.