Individual provider Active NPI

Lyndsey Jo Buderus, PT, DPT

  • Physical Therapist
  • Greeley, CO
National Provider Identifier
1235780792
Registry record updated Sep 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
0016624 Issued in CO
Practice address
4663 W 20TH Street Rd
Greeley, CO 80634-3246
Phone
(970) 352-8762
Fax
(970) 353-2081
NPI assigned
Sep 26, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2019

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 0016624 CO Primary

Addresses

Primary practice location

4663 W 20TH Street Rd
Greeley, CO 80634-3246

Mailing address

1856 23Rd Avenue CT
Greeley, CO 80634-6021
Phone (970) 302-0908

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191102000161 CO Practitioner - Physical Therapist in Private Practice 4183956667 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Point Sports Medicine and Rehabilitation IncGroup PAC ID 8325031313, 9 clinicians

Practice addresses (Care Compare)

4663 W 20TH St Rd
Greeley, CO 80634-3246
Phone (970) 352-8762

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0016624COMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
The Point Sports Medicine & Rehabilitation Inc. Physical Therapist CurrentSince Sep 25, 2019 Accepting new patients

Locations

4663 W 20th Street Rd
Greeley, CO 80634
Phone (970) 352-8762

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 and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1569456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569456000000",
    "number": "1235780792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1856 23RD AVENUE CT",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806346021",
            "telephone_number": "970-302-0908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4663 W 20TH STREET RD",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806343246",
            "telephone_number": "970-352-8762",
            "fax_number": "970-353-2081"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUDERUS",
        "first_name": "LYNDSEY",
        "middle_name": "JO",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-26",
        "last_updated": "2019-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "0016624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greeley, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2019; 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.