Individual provider Active NPI

Nicole M Vivlamore, DPT

  • Physical Therapist
  • Bowie, MD
National Provider Identifier
1457602567
Registry record updated Dec 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
24084 Issued in MD
Practice address
6842 Race Track Rd Ste B
Bowie, MD 20715-3011
Phone
(240) 544-0200
Fax
(301) 464-1053
NPI assigned
Sep 28, 2012
Last updated
Dec 8, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2022

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 24084 MD Primary

Addresses

Primary practice location

6842 Race Track Rd Ste B
Bowie, MD 20715-3011

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (866) 370-8206

Other practice location 1

2000 Medical Pkwy
Suite 101
Annapolis, MD 21401-3742
Phone (410) 295-8900 ext. 3318

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, MD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20121018000128 DC Practitioner - Physical Therapist in Private Practice 3678723160 Reassigns benefits to 2 organizations
I20121018000222 MD Practitioner - Physical Therapist in Private Practice 3678723160 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ati Holdings, LLCGroup PAC ID 9537112719, 440 clinicians

Practice addresses (Care Compare)

2327 Forest Dr
Suite D
Annapolis, MD 21401-3865
Phone (443) 782-7243

6842 Race Track Rd B
Bowie, MD 20715-3011
Phone (240) 544-0200

Merit-based Incentive Payment System (MIPS)

Final score
86.05 of 100Reported as group
Quality
89.12
Improvement activities
40
Cost
73.46

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
24084MDMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Sportscare & Rehab, LLC Physical Therapist CurrentSince Jun 5, 2020 Accepting new patients
Ati Holdings, LLC Physical Therapist CurrentSince Dec 5, 2022 Accepting new patients
Ati Holdings, LLC Physical Therapist CurrentSince Dec 5, 2022 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

4947 Paysphere Cir
Chicago, IL 60674
Phone (630) 783-2001

2327 Forest Dr
Ste D
Annapolis, MD 21401
Phone (443) 782-7243

6842 Race Track Rd
#B
Bowie, MD 20715
Phone (240) 544-0200

2987 Plaza Dr
Dunkirk, MD 20754
Phone (443) 964-6348

9 Lee Airpark Dr
Ste 400
Edgewater, MD 21037
Phone (443) 607-1469

1510 Rock Spring Rd
Ste C
Forest Hill, MD 21050
Phone (410) 420-3619

2389 Brandermill Blvd
Ste 103
Gambrills, MD 21054
Phone (410) 774-9821

2634 Brandermill Blvd
Gambrills, MD 21054
Phone (410) 721-7201

12913 Coastal Hwy
Ocean City, MD 21842
Phone (410) 213-7878

52 Rising Sun Town Ctr
Rising Sun, MD 21911
Phone (410) 658-0100

11271 New Hampshire Ave
Silver Spring, MD 20904
Phone (240) 485-1280

1600 Wilson Blvd
Ste 102
Arlington, VA 22209
Phone (301) 464-4500

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": "1348790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670457600000",
    "number": "1457602567",
    "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",
            "telephone_number": "866-370-8206",
            "fax_number": "517-435-3670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6842 RACE TRACK RD STE B",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207153011",
            "telephone_number": "240-544-0200",
            "fax_number": "301-464-1053"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2000 Medical Pkwy",
            "address_2": "SUITE 101",
            "address_purpose": "LOCATION",
            "city": "Annapolis",
            "state": "MD",
            "postal_code": "214013742",
            "country_code": "US",
            "telephone_number": "410-295-8900 x3318",
            "fax_number": "410-280-4701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VIVLAMORE",
        "first_name": "NICOLE",
        "middle_name": "M",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-28",
        "last_updated": "2022-12-08",
        "certification_date": "2022-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "24084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowie, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2022; 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.