Individual provider Active NPI

Anthony Pucci, DPT

  • Physical Therapist
  • Kirkwood, MO
National Provider Identifier
1073022919
Registry record updated Sep 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2017031954 Issued in MO
Practice address
333 S Kirkwood Rd
Kirkwood, MO 63122-6161
Phone
(314) 909-4848
NPI assigned
Sep 22, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2017

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 2017031954 MO Primary

Addresses

Primary practice location

333 S Kirkwood Rd
Kirkwood, MO 63122-6161

Mailing address

14515 N Outer 40 Rd
Chesterfield, MO 63017-5791
Phone (314) 434-8680

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171004001868 MO Practitioner - Physical Therapist in Private Practice 8820363625 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Training and Rehab LLCGroup PAC ID 2961487475, 29 clinicians

Practice addresses (Care Compare)

333 S Kirkwood Rd
Suite 201
Kirkwood, MO 63122-6161
Phone (314) 909-4848

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2017031954MOMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Training and Rehab LLC Physical Therapist CurrentSince Oct 2, 2017 Accepting new patients

Locations

333 S Kirkwood Rd
Ste 201
Saint Louis, MO 63122
Phone (314) 909-0517

14515 North Outer 40 Rd
Ste 110
Town and Country, MO 63017
Phone (314) 434-6060

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1506038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506038400000",
    "number": "1073022919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14515 N OUTER 40 RD",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630175791",
            "telephone_number": "314-434-8680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 S KIRKWOOD RD",
            "city": "KIRKWOOD",
            "state": "MO",
            "postal_code": "631226161",
            "telephone_number": "314-909-4848"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCCI",
        "first_name": "ANTHONY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-22",
        "last_updated": "2017-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2017031954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kirkwood, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2017; 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.