Individual provider Active NPI

Mark S Bromberg, MSPT

  • Physical Therapist
  • Bellevue, WA
National Provider Identifier
1033196092
Registry record updated Dec 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT00007431 Issued in WA
Practice address
3101 Northup Way Ste 101
Bellevue, WA 98004-1435
Phone
(425) 462-5006
Fax
(425) 462-5019
NPI assigned
Dec 29, 2005
Last updated
Dec 12, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT00007431 WA Primary

Addresses

Primary practice location

3101 Northup Way Ste 101
Bellevue, WA 98004-1435

Mailing address

510 8TH Ave NE Ste 320
Issaquah, WA 98029-5436
Phone (425) 462-5006

Other identifiers 1

IdentifierTypeStateIssuer
1000855MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040809000369 WA Practitioner - Physical Therapist in Private Practice 4082686324 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Proliance Surgeons Inc P SGroup PAC ID 8527972900, 395 clinicians

Practice addresses (Care Compare)

3101 Northup Way
Suite 101
Bellevue, WA 98004-1469
Phone (425) 462-5006

Merit-based Incentive Payment System (MIPS)

Final score
90.26 of 100Reported as apm
Quality
89.39
Promoting interoperability
85.23
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT00007431WAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Proliance Surgeons Inc P S Current Accepting new patients
Proliance Surgeons Inc P S CurrentSince Dec 16, 2024 Accepting new patients
Proliance Surgeons, Inc., P.S. Physical Therapist CurrentSince Dec 16, 2024 Accepting new patients
Northwest Center for Sports Medicine & Physical Therapy Inc Physical Therapist CurrentSince Jun 30, 2021 Accepting new patients
Northwest Center for Sports Medicine & Physical Therapy, Inc. Physical Therapist Past Accepting new patients

Locations

1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568

1200 112th Ave NE
Ste C260
Bellevue, WA 98004
Phone (425) 313-3055

3101 Northup Way
Ste 101
Bellevue, WA 98004
Phone (425) 462-5006

4411 Point Fosdick Dr
Ste 101
Gig Harbor, WA 98335
Phone (253) 851-7472

510 8th Ave NE
Ste 320
Issaquah, WA 98029

4550 Klahanie Dr SE
Sammamish, WA 98029
Phone (425) 391-2427

805 Madison St
Ste 901
Seattle, WA 98104
Phone (206) 264-8100

1550 S Union Ave
Ste 130
Tacoma, WA 98405
Phone (253) 552-2525

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733961600000",
    "number": "1033196092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 8TH AVE NE STE 320",
            "city": "ISSAQUAH",
            "state": "WA",
            "postal_code": "980295436",
            "telephone_number": "425-462-5006",
            "fax_number": "425-462-5019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 NORTHUP WAY STE 101",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980041435",
            "telephone_number": "425-462-5006",
            "fax_number": "425-462-5019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROMBERG",
        "first_name": "MARK",
        "middle_name": "S",
        "credential": "MSPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-29",
        "last_updated": "2024-12-12",
        "certification_date": "2024-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00007431",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1000855",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bellevue, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.