Individual provider Active NPI

Nicholas R Misener, DPT

  • Physical Therapist
  • Eldersburg, MD
National Provider Identifier
1417330986
Registry record updated Feb 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
25481 Issued in MD
Practice address
6300 Georgetown Blvd Ste 139
Eldersburg, MD 21784-6422
Phone
(410) 644-1880
Fax
(443) 300-3160
NPI assigned
Jul 2, 2015
Last updated
Feb 28, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2024

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 25481 MD Primary

Addresses

Primary practice location

6300 Georgetown Blvd Ste 139
Eldersburg, MD 21784-6422

Mailing address

6300 Georgetown Blvd Ste 139
Eldersburg, MD 21784-6422
Phone (410) 644-1880

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160115000071 MD Practitioner - Physical Therapist in Private Practice 2668775230 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10710 Charter Dr
Suite 300
Columbia, MD 21044-3260
Phone (410) 644-1880

6300 Georgetown Blvd
Eldersburg, MD 21784-6481
Phone (410) 644-1880

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
25481MDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Centers for Advanced Orthopaedics, LLC CurrentSince Jun 1, 2015 Accepting new patients
Centers for Advanced Orthopaedics, LLC CurrentSince Jun 1, 2015 Accepting new patients
Centers for Advanced Orthopaedics, LLC Current Accepting new patients
Orthopaedic Associates of Central Maryland, PA Past Accepting new patients

Locations

910 Frederick Rd
Catonsville, MD 21228

10710 Charter Dr
Ste 300
Columbia, MD 21044
Phone 4106441880450

86 Thomas Johnson Ct
Frederick, MD 21702
Phone (301) 607-0444

5961 Exchange Dr
Ste 100
Sykesville, MD 21784
Phone (410) 964-2212

6300 Georgetown Blvd
Ste 139
Sykesville, MD 21784

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, 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": "1435795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709078400000",
    "number": "1417330986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6300 GEORGETOWN BLVD STE 139",
            "city": "ELDERSBURG",
            "state": "MD",
            "postal_code": "217846422",
            "telephone_number": "410-644-1880",
            "fax_number": "443-300-3160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6300 GEORGETOWN BLVD STE 139",
            "city": "ELDERSBURG",
            "state": "MD",
            "postal_code": "217846422",
            "telephone_number": "410-644-1880",
            "fax_number": "443-300-3160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISENER",
        "first_name": "NICHOLAS",
        "middle_name": "R",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-02",
        "last_updated": "2024-02-28",
        "certification_date": "2024-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "25481",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eldersburg, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; 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.