Individual provider Active NPI

Alex Fogt, DPT

  • Physical Therapist
  • Goodyear, AZ
National Provider Identifier
1528614781
Registry record updated Jan 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
CP011725T Issued in MD
Practice address
380 N Estrella Pkwy Ste A1
Goodyear, AZ 85338-2885
Phone
(623) 322-0654
Fax
(623) 322-0664
NPI assigned
Aug 14, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2023

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X LPT-32055 AZ
Physical Therapist 225100000X PT210002132 DC
Physical Therapist 225100000X 05014613A IN
Physical Therapist 225100000X PT018257 OH
Physical Therapist 225100000X CP011725T MD Primary

Addresses

Primary practice location

380 N Estrella Pkwy Ste A1
Goodyear, AZ 85338-2885

Mailing address

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

Other practice location 1

962 Wayne Ave Ste L-D
Silver Spring, MD 20910-4433
Phone (301) 650-0036

Other practice location 2

4375 E Indian School Rd Ste 190
Phoenix, AZ 85018-5336
Phone (602) 789-3880

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Care Compare profile

Medicare Care Compare

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
PT210002132DCMDPhysical Therapist
CP011725TMDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Sportscare & Rehab, LLC Physical Therapist CurrentSince Aug 1, 2022 Accepting new patients
Ideal Rehabilitation LLC Past Accepting new patients

Locations

2122 York Rd
Ste 300
Oak Brook, IL 60523
Phone (630) 575-6250

962 Wayne Ave
Ste Ld
Silver Spring, MD 20910
Phone (301) 650-0036

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

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1565740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672617600000",
    "number": "1528614781",
    "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": "380 N ESTRELLA PKWY STE A1",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853382885",
            "telephone_number": "623-322-0654",
            "fax_number": "623-322-0664"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "962 Wayne Ave Ste L-D",
            "address_purpose": "LOCATION",
            "city": "Silver Spring",
            "state": "MD",
            "postal_code": "209104433",
            "country_code": "US",
            "telephone_number": "301-650-0036",
            "fax_number": "301-650-0038",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4375 E Indian School Rd Ste 190",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850185336",
            "country_code": "US",
            "telephone_number": "602-789-3880",
            "fax_number": "602-362-5393",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FOGT",
        "first_name": "ALEX",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-14",
        "last_updated": "2023-01-02",
        "certification_date": "2023-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "LPT-32055",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "DC",
            "license": "PT210002132",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05014613A",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OH",
            "license": "PT018257",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "CP011725T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Goodyear, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.