Individual provider Active NPI

Robert Budlong

  • Physical Therapist
  • Plymouth, MI
National Provider Identifier
1114478310
Registry record updated Nov 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501019820 Issued in MI
Practice address
9368 N Lilley Rd
Plymouth, MI 48170-4610
Phone
(734) 416-3900
Fax
(734) 453-2118
NPI assigned
Oct 23, 2016
Last updated
Nov 24, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X
Student in an Organized Health Care Education/Training Program 390200000X
Physical Therapist 225100000X 5501019820 MI Primary

Addresses

Primary practice location

9368 N Lilley Rd
Plymouth, MI 48170-4610

Mailing address

9368 N Lilley Rd
Plymouth, MI 48170-4610
Phone (734) 416-3900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201202001101 MI Practitioner - Physical Therapist in Private Practice 5890106595 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ivyrehab Michigan LLCGroup PAC ID 6901165893, 156 clinicians

Practice addresses (Care Compare)

3699 S Baldwin Rd
Lake Orion, MI 48359-1664
Phone (248) 997-5990

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Michigan, LLC Physical Therapist CurrentSince Oct 16, 2021 Accepting new patients

Locations

42727 Ford Rd
Canton, MI 48187
Phone (734) 418-4866

16071 15 Mile Rd
Clinton Township, MI 48035
Phone (586) 981-1086

3699 S Baldwin Rd
Lake Orion, MI 48359
Phone (248) 997-5990

135 S Milford Rd
Milford, MI 48381
Phone (248) 685-7272

1764 S Ortonville Rd
Ste 400
Ortonville, MI 48462
Phone (248) 793-5730

3856 S Rochester Rd
Rochester Hills, MI 48307
Phone (248) 233-4944

8158 Cooley Lake Rd
White Lake, MI 48386
Phone (248) 956-1894

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, 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": "1477180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606176000000",
    "number": "1114478310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9368 N LILLEY RD",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481704610",
            "telephone_number": "734-416-3900",
            "fax_number": "734-453-2118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9368 N LILLEY RD",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481704610",
            "telephone_number": "734-416-3900",
            "fax_number": "734-453-2118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUDLONG",
        "first_name": "ROBERT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-10-23",
        "last_updated": "2020-11-24",
        "certification_date": "2020-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501019820",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2020; 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.