NPIMap

Organization Active NPI

Bethesda Physiocare

  • Physical Therapist
  • Bethesda, MD
National Provider Identifier
1245437318
Registry record updated Apr 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
BETHESDA PHYSIOCARE
Practice address
7830 Old Georgetown Rd
Suite C15
Bethesda, MD 20814-2432
Phone
(301) 656-5613
Fax
(301) 656-6586
NPI assigned
Jul 1, 2007
Last updated
Apr 11, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2008

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

Authorized official

Name
Mr. Jan DommerholtNPI 1841335007
Title
President
Phone
(301) 656-5613

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X NU Primary

Addresses

Primary practice location

7830 Old Georgetown Rd
Suite C15
Bethesda, MD 20814-2432

Mailing address

7830 Old Georgetown Rd
Suite C15
Bethesda, MD 20814-2432
Phone (301) 656-5613

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080205000467 DC Part B Supplier - Clinic/Group Practice 6305929993 Receives reassigned benefits from 4 practitioners
Practice locations: Bethesda, MD

National Provider Directory

National Provider Directory

Locations

8120 Woodmont Ave
Ste 200
Bethesda, MD 20814
Phone (301) 656-5613

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1183248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207872000000",
    "number": "1245437318",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7830 OLD GEORGETOWN RD",
            "address_2": "SUITE C15",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208142432",
            "telephone_number": "301-656-5613",
            "fax_number": "301-656-6586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7830 OLD GEORGETOWN RD",
            "address_2": "SUITE C15",
            "city": "BETHESDA",
            "state": "MD",
            "postal_code": "208142432",
            "telephone_number": "301-656-5613",
            "fax_number": "301-656-6586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHESDA PHYSIOCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-01",
        "last_updated": "2008-04-11",
        "status": "A",
        "authorized_official_last_name": "DOMMERHOLT",
        "authorized_official_first_name": "JAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-656-5613",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bethesda, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.