Trung Tin Phan

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT015913 Issued in GA

Practice address

4310 Johns Creek Pkwy Ste 130
Suwanee, GA 30024-6092

Phone

(770) 738-9657

NPI assigned

Jun 20, 2022

Sex

Male

Sole proprietor

Yes

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 NV

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Emory University School of Medicine, 2022

Medicare assignment

May accept Medicare assignment

Group practices

Kime Performance Nevada LLCGroup PAC ID 0042620783, 7 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

77.03 of 100Reported as group

Quality

58.26

Improvement activities

40

Cost

79.08

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kime Performance Nevada LLC

  • Physical Therapy Clinic/Center
  • Reno, NV
  • NPI 1053918185
  Medicare reassignment Care Compare group NPD
• Mikla Dunning Physical Therapy Systems, PC

  dba KIME Performance

  • Physical Therapy Clinic/Center
  • El Dorado Hills, CA
  • NPI 1619334992
  NPD (past)

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

{
    "created_epoch": "1655683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655683200000",
    "number": "1093446221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2381 EASTWAY RD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300335543",
            "telephone_number": "916-719-1709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4310 JOHNS CREEK PKWY STE 130",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300246092",
            "telephone_number": "770-738-9657"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "TRUNG",
        "middle_name": "TIN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-06-20",
        "last_updated": "2022-06-20",
        "certification_date": "2022-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT015913",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• George Wells Petras, L.P.C.
• Kristie Petree, D.O.
• PF Transport Services, Inc.
• Jessica Hong Pham, PHARMD
• Kevin Phan, DDS
• Swaroop R Philkhana, DR
• Kathryn Cecelia Phillippe
• Ashdon Phillips, RBT
• Jessica Phillips, RBT
• Morgan Alexandria Phillips, BA, RBT

• Physical Therapist in Suwanee, GA
• Providers in Suwanee, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2022; 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.