Individual provider Active NPI

Wyatt Stephen Popovich

  • Physical Therapist
  • Folsom, PA
National Provider Identifier
1154090504
Registry record updated Sep 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
160 Morton Ave
Folsom, PA 19033-2510
Phone
(484) 496-2683
NPI assigned
Sep 9, 2021
Last updated
Sep 9, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2021

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 NU Primary

Addresses

Primary practice location

160 Morton Ave
Folsom, PA 19033-2510

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211006000648 PA Practitioner - Physical Therapist in Private Practice 4082012018 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ati Holdings, LLCGroup PAC ID 9537112719, 440 clinicians

Practice addresses (Care Compare)

160 Morton Ave
Folsom, PA 19033-2510
Phone (414) 496-2683

Merit-based Incentive Payment System (MIPS)

Final score
86.05 of 100Reported as group
Quality
89.12
Improvement activities
40
Cost
73.46

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ati Holdings, LLC Physical Therapist CurrentSince Sep 13, 2021 Accepting new patients
Ati Holdings, LLC Physical Therapist CurrentSince Sep 13, 2021 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

4947 Paysphere Cir
Chicago, IL 60674
Phone (630) 783-2001

5038 Pennell Rd
Aston, PA 19014
Phone (610) 833-4600

4828 Edgmont Ave
Brookhaven, PA 19015
Phone (610) 619-6284

160 Morton Ave
Folsom, PA 19033
Phone (414) 496-2683

826 E Baltimore Pike
Unit 9
Kennett Square, PA 19348
Phone (610) 335-1410

519 E Baltimore Pike
Media, PA 19063
Phone (484) 441-0622

9475 Roosevelt Blvd
Philadelphia, PA 19114
Phone (215) 464-6200

118 Townsedge Dr
Quarryville, PA 17566
Phone (717) 806-5126

Organizations & group practices 2

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": "1631145600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631145600000",
    "number": "1154090504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 MORTON AVE",
            "city": "FOLSOM",
            "state": "PA",
            "postal_code": "190332510",
            "telephone_number": "484-496-2683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POPOVICH",
        "first_name": "WYATT",
        "middle_name": "STEPHEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-09",
        "last_updated": "2021-09-09",
        "certification_date": "2021-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Folsom, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2021; 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.