Individual provider Active NPI

Brett Eric De Yager, DPT

  • Physical Therapist
  • Bellevue, WA
National Provider Identifier
1104266436
Registry record updated Feb 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT60389205 Issued in WA
Practice address
3101 Northup Way Ste 101
Bellevue, WA 98004-1469
Phone
(425) 462-5006
Fax
(425) 462-5019
NPI assigned
Jul 1, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PU60389208 WA
Physical Therapist 225100000X PT60389205 WA Primary

Addresses

Primary practice location

3101 Northup Way Ste 101
Bellevue, WA 98004-1469

Mailing address

510 8TH Ave NE Ste 320
Issaquah, WA 98029-5436
Phone (425) 507-0733

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130913000800 WA Practitioner - Physical Therapist in Private Practice 0345484226 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2013
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)

1200 112TH Ave NE
Suite C260
Bellevue, WA 98004-3746
Phone (425) 462-5006

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PU60389208WAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Proliance Surgeons Inc P S CurrentSince Oct 13, 2019 Accepting new patients
Proliance Surgeons, Inc., P.S. Physical Therapist CurrentSince Oct 13, 2019 Accepting new patients
Proliance Surgeons Inc P S Current Accepting new patients

Locations

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

510 8th Ave NE
Ste 320
Issaquah, WA 98029

12911 120th Ave NE
Ste H220
Kirkland, WA 98034
Phone (425) 216-7075

12911 120th Ave NE
Ste G10
Kirkland, WA 98034
Phone (425) 481-6301

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

Organizations & group practices 3

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": "1372636800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677024000000",
    "number": "1104266436",
    "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": "425-507-0733",
            "fax_number": "425-283-5551"
        },
        {
            "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": "980041469",
            "telephone_number": "425-462-5006",
            "fax_number": "425-462-5019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DE YAGER",
        "first_name": "BRETT",
        "middle_name": "ERIC",
        "name_prefix": "Mr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-01",
        "last_updated": "2023-02-22",
        "certification_date": "2023-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PU60389208",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60389205",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Feb 22, 2023; 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.