Individual provider Active NPI

Renuka Vishnu Wadhwa, DPT

  • Physical Therapist
  • Cambridge, MA
National Provider Identifier
1255814588
Registry record updated Aug 1, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PTL26831 Issued in MA
Practice address
1 Kendall SQ Ste B14104
Cambridge, MA 02139-1573
Phone
(617) 491-0264
Fax
(617) 491-4411
NPI assigned
Sep 12, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 1, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 05012755A IN
Physical Therapist 225100000X PTL26831 MA Primary

Addresses

Primary practice location

1 Kendall SQ Ste B14104
Cambridge, MA 02139-1573

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (866) 370-8206

Other practice location 1

3117 Courthouse Dr E Apt 1A
West Lafayette, IN 47906-1016
Phone (206) 487-6986

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230817000546 MA Practitioner - Physical Therapist in Private Practice 3971835133 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

101 University Dr
Suite A6
Amherst, MA 01002-2385
Phone (413) 336-5703

14 McGrath Hwy
Unit 5
Somerville, MA 02143-4505
Phone (617) 284-9418

Merit-based Incentive Payment System (MIPS)

Final score
85.19 of 100Reported as group
Quality
86.04
Improvement activities
40
Cost
76.23

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
05012755AINMDPhysical Therapist
PTL26831MAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Performance Rehabilitation of Western New England LLC Physical Therapist CurrentSince Aug 7, 2023 Accepting new patients
Performance Rehabilitation of Western New England LLC Physical Therapist CurrentSince Aug 7, 2023 Accepting new patients
Carl Gustafson LLC Physical Therapist Past Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

33377 Collection Ctr Dr
Chicago, IL 60693
Phone (617) 284-9418

101 University Dr
Ste A6
Amherst, MA 01002
Phone (413) 336-5703

1 Kendall Sq
Ste B14104
Cambridge, MA 02139
Phone (617) 491-0264

14 McGrath Hwy
Unit 5
Somerville, MA 02143
Phone (617) 284-9418

Organizations & group practices 3

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": "1536710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690848000000",
    "number": "1255814588",
    "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",
            "telephone_number": "866-370-8206",
            "fax_number": "517-435-3670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 KENDALL SQ STE B14104",
            "city": "CAMBRIDGE",
            "state": "MA",
            "postal_code": "021391573",
            "telephone_number": "617-491-0264",
            "fax_number": "617-491-4411"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3117 Courthouse Dr E Apt 1A",
            "address_purpose": "LOCATION",
            "city": "West Lafayette",
            "state": "IN",
            "postal_code": "479061016",
            "country_code": "US",
            "telephone_number": "206-487-6986",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WADHWA",
        "first_name": "RENUKA",
        "middle_name": "VISHNU",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-12",
        "last_updated": "2023-08-01",
        "certification_date": "2023-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05012755A",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "PTL26831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cambridge, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2023; 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.