NPIMap

Organization Active NPI

Performance Plus Rehabilitation Center LLC

  • Chiropractor
  • Saint Joseph, MO
National Provider Identifier
1962624510
Registry record updated Mar 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
CE006171 Issued in MO
Legal business name
PERFORMANCE PLUS REHABILITATION CENTER LLC
Practice address
1802 N Woodbine Rd.
St. Joseph, MO 64506
Phone
(816) 232-5113
Fax
(816) 232-0453
NPI assigned
May 3, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2012

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

Authorized official

Name
Pamela Therese Smith
Title
Office Manager
Phone
(816) 232-5113

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X CE006171 MO Primary
Rehabilitation ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111NR0400X CE006171 MO
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 2002011893 MO

Addresses

Primary practice location

1802 N Woodbine Rd.
St. Joseph, MO 64506

Mailing address

PO Box 6423
St. Joseph, MO 64506
Phone (816) 232-5113

Other identifiers 2

IdentifierTypeStateIssuer
20689030OtherMOBCBS
757861505MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20041207001169 MO Part B Supplier - Clinic/Group Practice 5294791695 Receives reassigned benefits from 9 practitioners
Practice locations: Cameron, MO; Saint Joseph, MO
O20090825000599 MO Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 5294791695 Practice locations: Cameron, MO; Gower, MO; Platte City, MO; Saint Joseph, MO

Outpatient physical therapy / speech pathology certification: CCN 266666

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
Performance Plus Rehabilitation Center
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
Oct 10, 2011
Last certification
Aug 29, 2023
Ownership / control type
Proprietary
Facility address
1802 North Woodbine Road
Saint Joseph, MO 64506

National Provider Directory

National Provider Directory

Locations

602 Lana Dr
Ste A
Cameron, MO 64429
Phone (816) 232-5113

1115 W Grand Ave
Cameron, MO 64429

1115 W Grand Ave
Ste A
Cameron, MO 64429
Phone (816) 233-5113

700 Branch St
Ste 10
Platte City, MO 64079
Phone (816) 232-5113

700 Branch St
#10
Platte City, MO 64079
Phone (816) 232-5113

1802 N Woodbine Rd
Saint Joseph, MO 64506
Phone (816) 232-5113

Practitioners & affiliated clinicians

Practitioners 12

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": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332288000000",
    "number": "1962624510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6423",
            "city": "ST. JOSEPH",
            "state": "MO",
            "postal_code": "64506",
            "telephone_number": "816-232-5113",
            "fax_number": "816-232-0453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1802 N WOODBINE RD.",
            "city": "ST. JOSEPH",
            "state": "MO",
            "postal_code": "64506",
            "telephone_number": "816-232-5113",
            "fax_number": "816-232-0453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERFORMANCE PLUS REHABILITATION CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2012-03-21",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "PAMELA",
        "authorized_official_middle_name": "THERESE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "816-232-5113"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "MO",
            "license": "CE006171",
            "primary": true
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor, Rehabilitation",
            "state": "MO",
            "license": "CE006171",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2002011893",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "20689030",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "757861505",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Joseph, MO

Sources for this page

Verify at the official NPI Registry.