Individual provider Active NPI

Josef Mielke, PT, DPT, OCS, CSCS

  • Physical Therapist
  • Travis Afb, CA
National Provider Identifier
1154783652
Registry record updated Dec 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT291268 Issued in CA
Practice address
101 Bodin Cir
Travis Afb, CA 94535-1809
Phone
(707) 423-3216
NPI assigned
Mar 23, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2022

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 PT291268 CA Primary

Addresses

Primary practice location

101 Bodin Cir
Travis Afb, CA 94535-1809

Mailing address

101 Bodin Cir
Travis Afb, CA 94535-1809
Phone (707) 423-3216

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160428002206 CA Practitioner - Physical Therapist in Private Practice 8325347115 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2015
Medicare assignment
May accept Medicare assignment
Group practices
Mikla Dunning Physical Therapy Systems PCGroup PAC ID 0941592067, 31 clinicians

Practice addresses (Care Compare)

1600 Tribute Rd
Sacramento, CA 95815-4400
Phone (916) 905-6378

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT291268CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
MDRS Spine & Sport, Inc Physical Therapist CurrentSince Apr 22, 2024 Accepting new patients
Mikla Dunning Physical Therapy Systems, PC CurrentSince Oct 17, 2024 Accepting new patients
California Luna Care Physical Therapy PC Physical Therapist CurrentSince Jan 12, 2022 Accepting new patients
MDRS Spine & Sport, Inc Physical Therapist CurrentSince Apr 22, 2024 Accepting new patients
Kime Performance Nevada LLC Past Accepting new patients

Locations

450 Rosewood Ave
Ste 105
Camarillo, CA 93010
Phone (805) 389-4781

1020 Tierra del Rey
Ste A1
Chula Vista, CA 91910
Phone (619) 585-7104

4990 Hillsdale Cir
Ste 100
El Dorado Hls, CA 95762
Phone (916) 342-4190

14150 Culver Dr
Ste 103
Irvine, CA 92604
Phone (949) 262-9142

16185 Los Gatos Blvd
Ste 205
Los Gatos, CA 95032
Phone (408) 459-8108

1600 Tribute Rd
Sacramento, CA 95815

9852 Business Park Dr
Ste A
Sacramento, CA 95827
Phone (916) 362-7962

1717 34th St
Sacramento, CA 95816

1801 Cleveland Ave
Ste B
Santa Rosa, CA 95401
Phone (707) 526-4180

5850 Canoga Ave
Ste 120
Woodland Hills, CA 91367
Phone (747) 255-4089

Organizations & group practices 5

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": "1458691200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670976000000",
    "number": "1154783652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 BODIN CIR",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "945351809",
            "telephone_number": "707-423-3216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 BODIN CIR",
            "city": "TRAVIS AFB",
            "state": "CA",
            "postal_code": "945351809",
            "telephone_number": "707-423-3216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIELKE",
        "first_name": "JOSEF",
        "name_prefix": "Mr.",
        "credential": "PT, DPT, OCS, CSCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-23",
        "last_updated": "2022-12-14",
        "certification_date": "2022-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT291268",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Travis Afb, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 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.