Individual provider Active NPI

Miranda A Congleton, DPT

  • Physical Therapist
  • Sudbury, MA
National Provider Identifier
1396383923
Registry record updated Dec 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
24658 Issued in MA
Practice address
141 Boston Post Rd
Sudbury, MA 01776-2405
Phone
(978) 295-5306
Fax
(978) 440-8117
NPI assigned
Dec 13, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 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 24658 MA Primary

Addresses

Primary practice location

141 Boston Post Rd
Sudbury, MA 01776-2405

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, PA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20191224000511 MA Practitioner - Physical Therapist in Private Practice 7012341100 Reassigns benefits to 1 organization
I20220928001643 PA Practitioner - Physical Therapist in Private Practice 7012341100 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

925 Chestnut St
FL 5
Philadelphia, PA 19107-4206
Phone (267) 339-3500

Merit-based Incentive Payment System (MIPS)

Final score
88.32 of 100Reported as group
Quality
79.04
Promoting interoperability
99
Improvement activities
40
Cost
82.85

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
24658MAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Reconstructive Orthopaedic Associates II LLC Physical Therapist CurrentSince Aug 18, 2022 Accepting new patients
Performance Rehabilitation of Western New England LLC Physical Therapist CurrentSince Jan 6, 2020 Accepting new patients
Performance Rehabilitation of Western New England LLC Physical Therapist CurrentSince Jan 6, 2020 Accepting new patients
Reconstructive Orthopaedic Associates II LLC CurrentSince Aug 18, 2022 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

33377 Collection Ctr Dr
Chicago, IL 60693
Phone (617) 284-9418

101 University Dr
Ste A6
Amherst, MA 01002
Phone (413) 336-5703

141 Boston Post Rd
Sudbury, MA 01776
Phone (781) 541-5111

833 Chestnut St
Ste 1220
Philadelphia, PA 19107
Phone (352) 200-2872

833 Chestnut St
Ste 520
Philadelphia, PA 19107
Phone (267) 592-6191

925 Chestnut St
Fl 5
Philadelphia, PA 19107
Phone (267) 339-3738

Organizations & group practices 4

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": "1576195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576195200000",
    "number": "1396383923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2222",
            "fax_number": "630-759-9510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 BOSTON POST RD",
            "city": "SUDBURY",
            "state": "MA",
            "postal_code": "017762405",
            "telephone_number": "978-295-5306",
            "fax_number": "978-440-8117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONGLETON",
        "first_name": "MIRANDA",
        "middle_name": "A",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-12-13",
        "last_updated": "2019-12-13",
        "certification_date": "2019-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "24658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sudbury, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 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.