Individual provider Active NPI

Bruce Gerard Sack, PT

  • Physical Therapist
  • Gainesville, FL
National Provider Identifier
1396750964
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT 4102 Issued in FL
Practice address
7701 SW 56TH Ave
Gainesville, FL 32608-4406
Phone
(352) 371-4637
NPI assigned
Jul 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 PT 4102 FL Primary

Addresses

Primary practice location

7701 SW 56TH Ave
Gainesville, FL 32608-4406

Mailing address

7701 SW 56TH Ave
Gainesville, FL 32608-4406
Phone (352) 371-4637

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070309000087 FL Practitioner - Physical Therapist in Private Practice 1658474812 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New Day Wellness LLCGroup PAC ID 8921101841, 4 clinicians

Practice addresses (Care Compare)

5201 Nw34Th Blvd
Gainesville, FL 32605-1153
Phone (352) 240-1136

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT 4102FLMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
New Day Wellness LLC CurrentSince Mar 13, 2007 Accepting new patients
New Day Wellness, LLC Physical Therapist Past Accepting new patients
New Day Wellness, LLC Physical Therapist Past Accepting new patients

Locations

5201 NW 34th Blvd
Gainesville, FL 32605
Phone (352) 240-1136

Organizations & group practices 3

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": "1154217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396750964",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7701 SW 56TH AVE",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326084406",
            "telephone_number": "352-371-4637"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7701 SW 56TH AVE",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326084406",
            "telephone_number": "352-371-4637"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SACK",
        "first_name": "BRUCE",
        "middle_name": "GERARD",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT 4102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.