Sungguk Bae

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

041263 Issued in NY

Practice address

21 Cleveland St
Patchogue, NY 11772-2815

Phone

(631) 569-9373

NPI assigned

Feb 15, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2019

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Movactive Therapy and Wellness, PLLC

  • Physical Therapy Clinic/Center
  • Plano, TX
  • NPI 1528759933
  Medicare reassignment NPD

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

{
    "created_epoch": "1518652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518652800000",
    "number": "1043710155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 CLEVELAND ST",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117722815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 CLEVELAND ST",
            "city": "PATCHOGUE",
            "state": "NY",
            "postal_code": "117722815",
            "telephone_number": "631-569-9373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAE",
        "first_name": "SUNGGUK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-15",
        "last_updated": "2018-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "041263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven B Axt, D.P.M.
• Nargis Ayoub, PHARMD
• Ramin Azarm, LCSW
• Ali Sayed Aziz, M.D.
• Amber Backer, LPN
• Pedro A Baez, MD
• Emma Bagdasarov, RN
• Kathleen Alyssa Bailey, DPT
• Margaret Gallagher Baird, CASAC, MHC-LP
• James Walter Banks Jr., LCSW

• Physical Therapist in Patchogue, NY
• Providers in Patchogue, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2018; 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.