Individual provider Active NPI

Shad Ray Schreiner, PT

  • Physical Therapist
  • Pueblo, CO
National Provider Identifier
1316259252
Registry record updated Jul 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PTL-10851 Issued in CO
Practice address
4112 Outlook Blvd
Suite #96
Pueblo, CO 81008-1667
Phone
(719) 562-6200
Fax
(719) 562-6225
NPI assigned
Jul 8, 2010
Last updated
Jul 8, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2010

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 PTL-10851 CO Primary

Addresses

Primary practice location

4112 Outlook Blvd
Suite #96
Pueblo, CO 81008-1667

Mailing address

4112 Outlook Blvd
Suite #96
Pueblo, CO 81008-1667
Phone (719) 562-6200

Other identifiers 1

IdentifierTypeStateIssuer
PTL-10851OtherCOSTATE LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190110002006 CO Practitioner - Physical Therapist in Private Practice 2769728872 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centura Ventures, LLCGroup PAC ID 8628989043, 30 clinicians

Practice addresses (Care Compare)

3010 N Circle Dr
120 Colorado Sports and Spine Centers
Colorado Springs, CO 80909-1182
Phone (719) 776-4888

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PTL-10851COMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Centura Ventures, LLC Physical Therapist CurrentSince Jan 1, 2019 Accepting new patients
Centura Ventures, LLC CurrentSince Jan 1, 2019 Accepting new patients

Locations

3010 N Circle Dr
Ste 120
Colorado Springs, CO 80909
Phone (719) 264-1500

3027 N Circle Dr
Colorado Springs, CO 80909
Phone (719) 577-2555

11960 Lioness Way
Ste 150
Parker, CO 80134
Phone (303) 269-2893

4112 Outlook Blvd
Pueblo, CO 81008
Phone (719) 553-1000

4112 Outlook Blvd
Ste 96
Pueblo, CO 81008
Phone (719) 562-6200

7233 Church Ranch Blvd
Westminster, CO 80021
Phone (303) 925-4137

41 State Highway 67
Unit C
Woodland Park, CO 80863
Phone (719) 686-0553

Organizations & group practices 2

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": "1278547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278547200000",
    "number": "1316259252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4112 OUTLOOK BLVD",
            "address_2": "SUITE #96",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810081667",
            "telephone_number": "719-562-6200",
            "fax_number": "719-562-6225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4112 OUTLOOK BLVD",
            "address_2": "SUITE #96",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810081667",
            "telephone_number": "719-562-6200",
            "fax_number": "719-562-6225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHREINER",
        "first_name": "SHAD",
        "middle_name": "RAY",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-07-08",
        "last_updated": "2010-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "PTL-10851",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "PTL-10851",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2010; 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.