Individual provider Active NPI

Trenton R Swoverland, P.T.

  • Physical Therapist
  • Fort Wayne, IN
National Provider Identifier
1407848419
Registry record updated Nov 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
05003232 Issued in IN
Practice address
9602 Coldwater Rd
Suite 102
Fort Wayne, IN 46825-2095
Phone
(260) 489-9887
Fax
(260) 489-9121
NPI assigned
Aug 16, 2005
Last updated
Nov 8, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2010

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 05003232 IN Primary

Addresses

Primary practice location

9602 Coldwater Rd
Suite 102
Fort Wayne, IN 46825-2095

Mailing address

9602 Coldwater Rd
Suite 102
Fort Wayne, IN 46825-2095
Phone (260) 489-9887

Other identifiers 1

IdentifierTypeStateIssuer
200374570AMedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110103000858 IN Practitioner - Physical Therapist in Private Practice 4688636897 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mallers and Swoverland Orthopaedic Physical TherapyGroup PAC ID 2961464169, 14 clinicians

Practice addresses (Care Compare)

9602 Coldwater Rd
Suite 102
Fort Wayne, IN 46825-2095
Phone (260) 489-9887

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
05003202INMDPhysical Therapist
05003232INMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Mallers & Swoverland Orthopaedic Physical Therapy Physical Therapist CurrentSince Apr 22, 2002 Accepting new patients
QHG of Fort Wayne Company, LLC Physical Therapist Past Accepting new patients
Redimed Dekalb LLC Physical Therapist Past Accepting new patients

Locations

9602 Coldwater Rd
Ste 102
Fort Wayne, IN 46825
Phone (260) 489-9887

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289174400000",
    "number": "1407848419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9602 COLDWATER RD",
            "address_2": "SUITE 102",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468252095",
            "telephone_number": "260-489-9887",
            "fax_number": "260-489-9121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9602 COLDWATER RD",
            "address_2": "SUITE 102",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468252095",
            "telephone_number": "260-489-9887",
            "fax_number": "260-489-9121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SWOVERLAND",
        "first_name": "TRENTON",
        "middle_name": "R",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-16",
        "last_updated": "2010-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05003232",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200374570A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2010; 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.