Individual provider Active NPI

Shivakumar Subbarayan, RPT

  • Physical Therapist
  • Hale, MI
National Provider Identifier
1225255367
Registry record updated Feb 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
3076 Northridge Rd
Hale, MI 48739-9277
Phone
(989) 728-0242
Fax
(989) 728-1144
NPI assigned
Apr 19, 2007
Last updated
Feb 5, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 5501008794 MI
Physical Therapist 225100000X MI Primary

Addresses

Primary practice location

3076 Northridge Rd
Hale, MI 48739-9277

Mailing address

3076 Northridge Rd
Hale, MI 48739-9277
Phone (989) 728-0242

Other identifiers 1

IdentifierTypeStateIssuer
4621772MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040209001088 MI Practitioner - Physical Therapist in Private Practice 3476447707 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Progress Physical Therapy IncGroup PAC ID 5698669919, 23 clinicians

Practice addresses (Care Compare)

3076 Northridge Rd
Hale, MI 48739-9277
Phone (989) 728-0242

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Progress Physical Therapy Inc Physical Therapist CurrentSince Aug 20, 2003 Accepting new patients

Locations

3076 Northridge Rd
Hale, MI 48739
Phone (989) 728-0242

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": "1176940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738713600000",
    "number": "1225255367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3076 NORTHRIDGE RD",
            "city": "HALE",
            "state": "MI",
            "postal_code": "487399277",
            "telephone_number": "989-728-0242",
            "fax_number": "989-728-1144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3076 NORTHRIDGE RD",
            "city": "HALE",
            "state": "MI",
            "postal_code": "487399277",
            "telephone_number": "989-728-0242",
            "fax_number": "989-728-1144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUBBARAYAN",
        "first_name": "SHIVAKUMAR",
        "credential": "RPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-19",
        "last_updated": "2025-02-05",
        "certification_date": "2025-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MI",
            "license": "5501008794",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4621772",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hale, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2025; 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.