John Howard Bradford, MSPT
Individual provider Active NPI Physical Therapist · Salem, CT
NPI 1508971003 · NPPES record last updated Jun 29, 2011
Key facts
- NPI
- 1508971003
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 006963 (CT)
- Practice address
- 11 Centre St
Suite 6&7
Salem, CT 06420-3844 - Phone
- (860) 949-2561
- Fax
- (860) 471-8388
- NPI assigned
- Aug 21, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Northeast Medical Group, PLLC
Practice addresses (Care Compare)
11 Centre St
Suite 6And7
Salem, CT 06420-3844
Phone (860) 949-2561
66 Hound LN
Fishers Island, NY 06390-7977
Phone (631) 788-7244
Merit-based Incentive Payment System (MIPS)
- Final score
- 100 of 100
- Quality
- 86.54
- Promoting interoperability
- 99.98
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CT, NY
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110818000342 | CT | Practitioner - Physical Therapist in Private Practice | 8426135724 | Reassigns benefits to 1 organization |
| I20230623001088 | NY | Practitioner - Physical Therapist in Private Practice | 8426135724 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8020 | AZ | MD | Physical Therapist |
| 006963 | CT | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Physiocare Physical Therapy and Sports Medicine, LLC | Physical Therapist | Current |
Accepting new patients |
| Northeast Medical Group, PLLC | Current |
Accepting new patients | |
| Physiocare Physical Therapy and Sports Medicine, LLC | Physical Therapist | Current |
Accepting new patients |
| Therapy Works Pediatrics | Past | Accepting new patients |
Locations
131 Boston Post Rd
East Lyme, CT 06333
Phone (860) 691-1044
20 York St
Fl 3
New Haven, CT 06510
Phone (203) 688-0715
18 Rye Ridge Plz
Rye Brook, NY 10573
Phone (914) 253-9252
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 006963 | CT | Yes |
| Physical Therapist | 225100000X | 8020 | AZ |
Addresses
Primary practice location
11 Centre St
Suite 6&7
Salem, CT 06420-3844
Mailing address
11 Cottage Rd
Bozrah, CT 06334-1412
Phone (860) 608-2773
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004221868-02 | Medicaid | CT |
Other providers in Salem, CT
- Nicole Elizabeth Aldridge
- Jennah Bakke
- Lauren Sisk Bradford
- Joshua Cappello
- Lindsay Cochefski
- Shannon Demi
- Natalie D Edwards
All providers in Salem, CT · Physical Therapist in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 29, 2011. 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.