Individual provider Active NPI

Mirsada Gudic, DPT

  • Physical Therapist
  • Washington, DC
National Provider Identifier
1366830457
Registry record updated Jan 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT024208 Issued in PA
Practice address
650 Pennsylvania Ave SE Ste 170
Washington, DC 20003
Phone
(202) 544-4874
NPI assigned
Dec 26, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2019

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 PT024208 PA Primary

Addresses

Primary practice location

650 Pennsylvania Ave SE Ste 170
Washington, DC 20003

Mailing address

5252 Lyngate CT Ste 203
Burke, VA 22015-1673
Phone (703) 239-2300

Other practice location 1

510 Brookmont Dr
Effort, PA 18330-9534
Phone (610) 681-4070

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170330000634 DC Practitioner - Physical Therapist in Private Practice 1355626599 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bethesda Chevy Chase Orthopaedic Associates, LLCGroup PAC ID 4789631011, 138 clinicians

Practice addresses (Care Compare)

10215 Fernwood Rd
Suite 506
Bethesda, MD 20817-1184
Phone (301) 530-1010

9601 Blackwell Rd
Suite 100
Rockville, MD 20850-6477
Phone (301) 340-9200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
26383MDMDPharmacist
PT024208PAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ati Holdings, LLC Physical Therapist CurrentSince May 31, 2021 Accepting new patients
Healthpro Heritage Rehab & Fitness, LLC Physical Therapist CurrentSince Apr 25, 2017 Accepting new patients
MGPT, LLC Current Accepting new patients
Ati Holdings, LLC Physical Therapist CurrentSince May 31, 2021 Accepting new patients
Healthpro Heritage Rehab & Fitness, LLC Physical Therapist CurrentSince Apr 25, 2017 Accepting new patients
Hand Therapy Experts, LLC Past Accepting new patients
Active Physical Therapy Services, LLC Physical Therapist Past Accepting new patients
Progressive Physical Therapy, LLC Physical Therapist Past Accepting new patients

Locations

4947 Paysphere Cir
Chicago, IL 60674
Phone (630) 783-2001

11271 New Hampshire Ave
Silver Spring, MD 20904
Phone (240) 485-1280

536 Old Howell Rd
Greenville, SC 29615
Phone (877) 508-3237

Organizations & group practices 9

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": "1419552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548633600000",
    "number": "1366830457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5252 LYNGATE CT STE 203",
            "city": "BURKE",
            "state": "VA",
            "postal_code": "220151673",
            "telephone_number": "703-239-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 PENNSYLVANIA AVE SE STE 170",
            "city": "WASHINGTON",
            "state": "DC",
            "postal_code": "20003",
            "telephone_number": "202-544-4874"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "510 Brookmont Dr",
            "address_purpose": "LOCATION",
            "city": "Effort",
            "state": "PA",
            "postal_code": "183309534",
            "country_code": "US",
            "telephone_number": "610-681-4070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUDIC",
        "first_name": "MIRSADA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-12-26",
        "last_updated": "2019-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT024208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Washington, DC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2019; 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.