NPIMap

Organization Active NPI

Shine Pediatric Therapy

  • Occupational Therapist
  • Springfield, TN
National Provider Identifier
1891041133
Registry record updated Sep 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
3432 Issued in TN
Legal business name
SHINE PEDIATRIC THERAPY
Practice address
514 S Brown St
Suite 600
Springfield, TN 37172-2937
Phone
(615) 382-0500
Fax
(615) 382-0501
NPI assigned
Jul 24, 2012
Last updated
Sep 2, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2019

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

Authorized official

Name
Denise Thompson
Title
Billing/Credentialing Manager
Phone
(615) 476-9730

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 3432 TN Primary

Addresses

Primary practice location

514 S Brown St
Suite 600
Springfield, TN 37172-2937

Mailing address

PO Box 1637
Springfield, TN 37172-1637
Phone (615) 382-0500

Other names 1

  • Springfield Pediatric Therapy, LLC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121008000085 TN Part B Supplier - Physical/Occupational Therapy Group in Private Practice 3577712538 Receives reassigned benefits from 1 practitioner
Practice locations: Springfield, TN

National Provider Directory

National Provider Directory

Locations

20 Executive Park Dr
Hendersonville, TN 37075
Phone (615) 994-8430

1414 Old Hickory Blvd
Nashville, TN 37207

3933 Memorial Blvd
Springfield, TN 37172
Phone (615) 203-0900

514 S Brown St
Ste 600
Springfield, TN 37172
Phone (615) 382-0500

Practitioners & affiliated clinicians

Practitioners 44

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 44

NPI Registry JSON

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

{
    "created_epoch": "1343088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567382400000",
    "number": "1891041133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1637",
            "city": "SPRINGFIELD",
            "state": "TN",
            "postal_code": "371721637",
            "telephone_number": "615-382-0500",
            "fax_number": "615-382-0501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 S BROWN ST",
            "address_2": "SUITE 600",
            "city": "SPRINGFIELD",
            "state": "TN",
            "postal_code": "371722937",
            "telephone_number": "615-382-0500",
            "fax_number": "615-382-0501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHINE PEDIATRIC THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-24",
        "last_updated": "2019-09-02",
        "status": "A",
        "authorized_official_last_name": "THOMPSON",
        "authorized_official_first_name": "DENISE",
        "authorized_official_title_or_position": "BILLING/CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "615-476-9730"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "TN",
            "license": "3432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Springfield Pediatric Therapy, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Springfield, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 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.