John Paul Bumgardner, PT
Individual provider Active NPI Specialist · Petal, MS
NPI 1447359229 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1447359229
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- PT3992 (MS)
- Practice address
- 1145 Highway 42
Petal, MS 39465-9740 - Phone
- (601) 544-0500
- Fax
- (601) 544-0505
- NPI assigned
- Sep 21, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 9
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Encore Rehabilitation, Inc
Practice addresses (Care Compare)
1411 Bradley Ave
Beaumont, MS 39423-0605
Phone (769) 390-8080
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060222000618 | MS | Practitioner - Physical Therapist in Private Practice | 2769498195 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Encore Rehabilitation, Inc. | Current |
Accepting new patients | |
| Encore Rehabilitation, Inc. | Current |
Accepting new patients |
Locations
251 Johnston St SE
Ste 300
Decatur, AL 35601
Phone (256) 340-9708
42465 Highway 195
Haleyville, AL 35565
Phone (205) 486-2753
1215 Highway 98 Byp
Columbia, MS 39429
Phone (601) 268-5070
433 Main St
Leakesville, MS 39451
Phone (601) 394-4545
1145 Highway 42
Petal, MS 39465
Phone (601) 544-0500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | PT3992 | MS | Yes |
Addresses
Primary practice location
1145 Highway 42
Petal, MS 39465-9740
Mailing address
322 Baker St
Petal, MS 39465-3806
Phone (601) 467-3442
Other providers in Petal, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.