NPIMap

Organization Active NPI

Star Rehab Prof Physicians, LLC

Doing business as Star Rehab, LLC

  • Pain Medicine (Physical Medicine & Rehabilitation) Physician
  • Pueblo West, CO
National Provider Identifier
1922000421
Registry record updated Aug 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X
License
39112 Issued in CO
Legal business name
STAR REHAB PROF PHYSICIANS, LLC
Doing business as
Star Rehab, LLC
Practice address
201 S McCulloch Blvd
Pueblo West, CO 81007-2892
Phone
(719) 561-5377
NPI assigned
Aug 15, 2005
Last updated
Aug 6, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2009

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

Authorized official

Name
Lynda Mariko Tsuha
Title
Coo
Phone
(719) 561-5377

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 44011 CO
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X 31344 KS
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X 39112 CO Primary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X 04-31652 KS

Addresses

Primary practice location

201 S McCulloch Blvd
Pueblo West, CO 81007-2892

Mailing address

PO Box 8867
Pueblo, CO 81008-8867
Phone (719) 561-5377

Other identifiers 4

IdentifierTypeStateIssuer
DE2582OtherKSRR MEDICARE
200362680AMedicaidKS
53283589MedicaidCO
DE2582OtherCORR MEDICARE

Other names 1

  • Star Rehab, LLC Doing business as

National Provider Directory

National Provider Directory

Locations

1048 Independent Ave
Ste 119
Grand Junction, CO 81505
Phone (719) 561-5377

4109 N Elizabeth St
Pueblo, CO 81008
Phone (719) 561-5377

1105 Main St
Ste C
Great Bend, KS 67530
Phone (620) 793-8600

Practitioners & affiliated clinicians

Practitioners 8

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": "1124064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1249516800000",
    "number": "1922000421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8867",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810088867",
            "telephone_number": "719-561-5377",
            "fax_number": "719-561-5378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 S MCCULLOCH BLVD",
            "city": "PUEBLO WEST",
            "state": "CO",
            "postal_code": "810072892",
            "telephone_number": "719-561-5377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAR REHAB PROF PHYSICIANS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-15",
        "last_updated": "2009-08-06",
        "status": "A",
        "authorized_official_last_name": "TSUHA",
        "authorized_official_first_name": "LYNDA",
        "authorized_official_middle_name": "MARIKO",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "719-561-5377"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "44011",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "KS",
            "license": "31344",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "CO",
            "license": "39112",
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "KS",
            "license": "04-31652",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DE2582",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200362680A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "53283589",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DE2582",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Star Rehab, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pueblo West, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.