Domeciano Bretana
Individual provider Active NPI Contractor · Indianapolis, IN
NPI 1376726265 · NPPES record last updated Dec 13, 2007
Key facts
- NPI
- 1376726265
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 05009464A (IN)
- Practice address
- 5980 W 71St St Ste 102
Indianapolis, IN 46278-2711 - Phone
- (317) 388-0800
- Fax
- (317) 388-0805
- NPI assigned
- Dec 13, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Select Rehabilitation, LLC
Practice addresses (Care Compare)
4300 Cleveland Ave
Michigan City, IN 46360-7683
Phone (219) 872-6800
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260519000726 | IN | Practitioner - Physical Therapist in Private Practice | 8325517428 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05009464A | IN | MD | Contractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Access Therapies,Inc | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 05009464A | IN | Yes |
Addresses
Primary practice location
5980 W 71St St Ste 102
Indianapolis, IN 46278-2711
Mailing address
5980 W 71St St Ste 102
Indianapolis, IN 46278-2711
Phone (317) 388-0800
Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 13, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.