Individual provider Active NPI

Shane Michael Bucher, DPT

  • Physical Therapist
  • Philadelphia, PA
National Provider Identifier
1336484062
Registry record updated May 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT030337 Issued in PA
Practice address
1528 Walnut St Ste 1210
Philadelphia, PA 19102-3609
Phone
(215) 839-0989
Fax
(215) 600-2228
NPI assigned
Dec 6, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 5, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT60314774 WA
Physical Therapist 225100000X 038924 NY
Physical Therapist 225100000X PT030337 PA Primary

Addresses

Primary practice location

1528 Walnut St Ste 1210
Philadelphia, PA 19102-3609

Mailing address

1311 Mamaroneck Ave Ste 140
White Plains, NY 10605-5224
Phone (914) 294-4050

Other practice location 1

1655 Elmwood Ave Ste 130
Rochester, NY 14620
Phone (585) 442-9110

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220513000053 PA Practitioner - Physical Therapist in Private Practice 1456585520 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Progress Physical Therapy LLCGroup PAC ID 1951530849, 430 clinicians

Practice addresses (Care Compare)

1919 Chestnut St
Suite 104
Philadelphia, PA 19103-3456
Phone (215) 564-1110

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038924NYMDClinical Social Worker
PT030337PAMDPhysical Therapist
PT60314774WAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopedic and Sports Physical Therapy Services, Inc. Physical Therapist CurrentSince Aug 15, 2022 Accepting new patients
Progress Physical Therapy LLC Physical Therapist CurrentSince Apr 15, 2022 Accepting new patients

Locations

1311 Mamaroneck Ave
Ste 140
White Plains, NY 10605
Phone (914) 265-4838

1175 Lancaster Ave
Berwyn, PA 19312
Phone (610) 651-8282

1919 Chestnut St
Ste 104
Philadelphia, PA 19103
Phone (215) 564-1110

517 S 4th St
Philadelphia, PA 19147
Phone (215) 629-1270

1528 Walnut St
Ste 1210
Philadelphia, PA 19102
Phone (215) 839-0989

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1354752000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651708800000",
    "number": "1336484062",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 MAMARONECK AVE STE 140",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106055224",
            "telephone_number": "914-294-4050",
            "fax_number": "631-760-8306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1528 WALNUT ST STE 1210",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191023609",
            "telephone_number": "215-839-0989",
            "fax_number": "215-600-2228"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1655 Elmwood Ave Ste 130",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "NY",
            "postal_code": "14620",
            "country_code": "US",
            "telephone_number": "585-442-9110",
            "fax_number": "585-442-9049",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUCHER",
        "first_name": "SHANE",
        "middle_name": "MICHAEL",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-12-06",
        "last_updated": "2022-05-05",
        "certification_date": "2022-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60314774",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "038924",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT030337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2022; 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.