NPIMap

Organization Active NPI

Destination Rehab

  • Physical Therapist
  • Bend, OR
National Provider Identifier
1891230942
Registry record updated Feb 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
DESTINATION REHAB
Practice address
64745 Melinda CT
Bend, OR 97701
Phone
(541) 241-6837
Fax
(971) 242-4088
NPI assigned
Dec 28, 2016
Last updated
Feb 24, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2020

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

Authorized official

Name
Carol-Ann Nelson, PTNPI 1285075002
Title
Executive Director
Phone
(541) 241-6837

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 Therapist 225100000X NU Primary

Addresses

Primary practice location

64745 Melinda CT
Bend, OR 97701

Mailing address

PO Box 8316
Bend, OR 97708
Phone (541) 241-6837

Other practice location 1

62629 Hawkview Rd
Bend, OR 97701-9597
Phone (541) 241-6837

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200428000942 OR Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7113357435 Receives reassigned benefits from 5 practitioners
Practice locations: Bend, OR

National Provider Directory

National Provider Directory

Locations

2843 NW Lolo Dr
Bend, OR 97703
Phone (541) 241-6837

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1482883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582502400000",
    "number": "1891230942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8316",
            "city": "BEND",
            "state": "OR",
            "postal_code": "97708",
            "telephone_number": "541-241-6837",
            "fax_number": "971-242-4088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "64745 MELINDA CT",
            "city": "BEND",
            "state": "OR",
            "postal_code": "97701",
            "telephone_number": "541-241-6837",
            "fax_number": "971-242-4088"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "62629 Hawkview Rd",
            "address_purpose": "LOCATION",
            "city": "Bend",
            "state": "OR",
            "postal_code": "977019597",
            "country_code": "US",
            "telephone_number": "541-241-6837",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DESTINATION REHAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-12-28",
        "last_updated": "2020-02-24",
        "certification_date": "2020-02-24",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "CAROL-ANN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "541-241-6837",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bend, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2020; 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.