Individual provider Active NPI

Derek Allen Wengert

  • Physical Therapist
  • Tucson, AZ
National Provider Identifier
1437853595
Registry record updated May 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
5660 W Cortaro Farms Rd Ste 108
Tucson, AZ 85742-9800
Phone
(520) 462-6167
Fax
(602) 795-8447
NPI assigned
Mar 30, 2023
Last updated
May 15, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X AZ Primary
Orthopedic Physical Therapist 2251X0800X 1275711897 UT

Addresses

Primary practice location

5660 W Cortaro Farms Rd Ste 108
Tucson, AZ 85742-9800

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909

Other practice location 1

83 S 2600 W
Hurricane, UT 84737-3266
Phone (435) 635-9333

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230928002748 UT Practitioner - Physical Therapist in Private Practice 3173977840 Reassigns benefits to 1 organization
I20240509001215 AZ Practitioner - Physical Therapist in Private Practice 3173977840 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ati Holdings of Arizona LLCGroup PAC ID 2466732862, 223 clinicians

Practice addresses (Care Compare)

5660 W Cortaro Farms Rd
Suite 108
Tucson, AZ 85742-9800
Phone (520) 462-6167

Merit-based Incentive Payment System (MIPS)

Final score
86.09 of 100Reported as group
Quality
89.13
Improvement activities
40
Cost
73.57

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1275711897UTMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Gubler's Physical Therapy Physical Therapist CurrentSince Aug 18, 2023 Accepting new patients
Ati Holdings of Arizona, LLC Physical Therapist CurrentSince Mar 29, 2024 Accepting new patients
Ideal Rehabilitation LLC Past Accepting new patients

Locations

1485 E Florence Blvd
Ste 105
Casa Grande, AZ 85122
Phone (520) 494-3058

12162 N Rancho Vistoso Blvd
Ste 120
Oro Valley, AZ 85755
Phone (520) 229-0009

11209 N Tatum Blvd
Ste B120
Phoenix, AZ 85028
Phone (602) 595-0204

5110 S Rural Rd
Ste 104
Tempe, AZ 85282
Phone (480) 629-5549

1020 S Harrison Rd
Unit 120
Tucson, AZ 85748
Phone (520) 207-6288

5660 W Cortaro Farms Rd
Ste 108
Tucson, AZ 85742
Phone (520) 462-6167

6261 N La Cholla Blvd
Ste 211
Tucson, AZ 85741
Phone (520) 229-3300

790 Remington Blvd
Bolingbrook, IL 60440

83 S 2600 W
Ste 201
Hurricane, UT 84737
Phone (435) 635-9333

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": "1680134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1437853595",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5660 W CORTARO FARMS RD STE 108",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857429800",
            "telephone_number": "520-462-6167",
            "fax_number": "602-795-8447"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "83 S 2600 W",
            "address_purpose": "LOCATION",
            "city": "Hurricane",
            "state": "UT",
            "postal_code": "847373266",
            "country_code": "US",
            "telephone_number": "435-635-9333",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WENGERT",
        "first_name": "DEREK",
        "middle_name": "ALLEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-30",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": null,
            "primary": true
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "UT",
            "license": "1275711897",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 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.