Brady Supriadi, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT301113 Issued in CA

Practice address

8545 Sierra Ave
Fontana, CA 92335-3868

Phone

(909) 365-3557

Fax

(909) 658-8987

NPI assigned

Nov 1, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

California Luna Care Physical Therapy PCGroup PAC ID 9638427834, 769 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• California Luna Care Physical Therapy PC

  • Physical Therapist
  • Los Gatos, CA
  • NPI 1689162166
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1635724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635724800000",
    "number": "1346905841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8545 SIERRA AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923353868",
            "telephone_number": "909-365-3557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8545 SIERRA AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923353868",
            "telephone_number": "909-365-3557",
            "fax_number": "909-658-8987"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPRIADI",
        "first_name": "BRADY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-11-01",
        "last_updated": "2021-11-01",
        "certification_date": "2021-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT301113",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charmaine C Sunga, BSN, RN
• Anujna Sunil
• Sunshine Medical Transportation LLC
• Sunshine Transportation
• Emily Suos
• David Sur, PHARM.D
• Krishna M Surti, MD
• Nancy M Svitek, M.D.
• Dexa Jo Swanson, RPH
• Jon R Swanson, LCSW

• Physical Therapist in Fontana, CA
• Providers in Fontana, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2021; 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.