NPIMap

Individual provider Active NPI

Sikander M Bajwa, MAOM, PT

  • Physical Therapist
  • Ellisville, MO
National Provider Identifier
1295908358
Registry record updated Sep 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2000174761 Issued in MO
Practice address
1519 Virginia Dr
Ellisville, MO 63011-2046
Phone
(314) 616-1276
Fax
(314) 741-3801
NPI assigned
Apr 9, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 15, 2021

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 1011293 IL
Home Health Agency 251E00000X 830-HH MO
Physical Therapist 225100000X 2000174761 MO Primary

Addresses

Primary practice location

1519 Virginia Dr
Ellisville, MO 63011-2046

Mailing address

1519 Virginia Dr
Ellisville, MO 63011-2046
Phone (314) 616-1276

Other identifiers 1

IdentifierTypeStateIssuer
2714157826222601MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1011293ILMDHome Health Agency
830-HHMOMDHome Health Agency

Practice roles

OrganizationSpecialtyStatusNew patients
Crescent Home Health Agency, LLC Home Health PastSince Feb 4, 2008 Accepting new patients
Crescent Home Health Agency, LLC Home Health PastSince Apr 8, 2010 Accepting new patients
Crescent Home Care, LLC Past Accepting new patients

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": "1207699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631664000000",
    "number": "1295908358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1519 VIRGINIA DR",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112046",
            "telephone_number": "314-616-1276",
            "fax_number": "314-741-3801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1519 VIRGINIA DR",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112046",
            "telephone_number": "314-616-1276",
            "fax_number": "314-741-3801"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAJWA",
        "first_name": "SIKANDER",
        "middle_name": "M",
        "name_prefix": "Mr.",
        "credential": "MAOM, PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-09",
        "last_updated": "2021-09-15",
        "certification_date": "2021-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "IL",
            "license": "1011293",
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MO",
            "license": "830-HH",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2000174761",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2714157826222601",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellisville, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.