NPIMap

Organization Active NPI

Quality Rehab Inc

  • Family Medicine Physician
  • Colorado Springs, CO
National Provider Identifier
1992330500
Registry record updated Nov 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
QUALITY REHAB INC
Practice address
3604 Galley Rd Ste 201
Colorado Springs, CO 80909-4301
Phone
(719) 638-4548
NPI assigned
Mar 4, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 30, 2020

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

Authorized official

Name
Jason Yisu ParkNPI 1447458369
Title
Ceo
Phone
(719) 550-4613

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Primary Care Clinic/Center 261QP2300X

Addresses

Primary practice location

3604 Galley Rd Ste 201
Colorado Springs, CO 80909-4301

Mailing address

3604 Galley Rd Ste 201
Colorado SPGS, CO 80909-4301
Phone (719) 635-4548

Other identifiers 1

IdentifierTypeStateIssuer
9000177586MedicaidCO

Other names 1

  • Quality Medical Clinic Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1583280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606694400000",
    "number": "1992330500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3604 GALLEY RD STE 201",
            "city": "COLORADO SPGS",
            "state": "CO",
            "postal_code": "809094301",
            "telephone_number": "719-635-4548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3604 GALLEY RD STE 201",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809094301",
            "telephone_number": "719-638-4548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUALITY REHAB INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-04",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "YISU",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "719-550-4613"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9000177586",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Quality Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Quality Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2020; 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.