Individual provider Active NPI

Kristin Richardson

  • Physical Medicine & Rehabilitation Physician
  • Fountain, CO
National Provider Identifier
1548831795
Registry record updated Dec 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
PTL.0017685 Issued in CO
Practice address
901 N Santa Fe Ave
Fountain, CO 80817-1738
Phone
(719) 822-0550
NPI assigned
Jul 8, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2023

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
Physical Medicine & Rehabilitation Physician 208100000X PTL.0017685 CO Primary

Addresses

Primary practice location

901 N Santa Fe Ave
Fountain, CO 80817-1738

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909

Other practice location 1

1071 W Blue Starr Dr
Claremore, OK 74017-2868
Phone (918) 341-4343

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230930000652 TX Practitioner - Physical Therapist in Private Practice 8729432307 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
85.56 of 100Reported as group
Quality
89.48
Improvement activities
40
Cost
71.16

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ideal Physical Therapy of Texas LLC CurrentSince Jan 22, 2024 Accepting new patients
Ideal Physical Therapy of Texas LLC Physical Therapist CurrentSince Jan 22, 2024 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

17051 Dallas Pkwy
Ste 450
Addison, TX 75001
Phone (214) 272-8561

4100 Fairway Dr
Ste 400
Carrollton, TX 75010
Phone (972) 394-3325

6029 Forest Ln
Dallas, TX 75230
Phone (469) 872-7548

2600 W 7th St
Ste 137
Fort Worth, TX 76107
Phone (682) 233-6462

410 W FM 544
Ste 105
Murphy, TX 75094
Phone (469) 606-5003

5400 Brodie Ln
Ste 295
Sunset Valley, TX 78745
Phone (512) 676-3949

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": "1625702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702944000000",
    "number": "1548831795",
    "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": "901 N SANTA FE AVE",
            "city": "FOUNTAIN",
            "state": "CO",
            "postal_code": "808171738",
            "telephone_number": "719-822-0550"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1071 W Blue Starr Dr",
            "address_purpose": "LOCATION",
            "city": "Claremore",
            "state": "OK",
            "postal_code": "740172868",
            "country_code": "US",
            "telephone_number": "918-341-4343",
            "fax_number": "918-341-8687",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "KRISTIN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-08",
        "last_updated": "2023-12-19",
        "certification_date": "2023-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CO",
            "license": "PTL.0017685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fountain, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2023; 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.