Individual provider Active NPI

Brian Jonathan Hudson, PT

  • Physical Therapist
  • Indio, CA
National Provider Identifier
1548930258
Registry record updated Sep 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
18254 Issued in CA
Practice address
46900 Monroe St Ste 304
Indio, CA 92201-4829
Phone
(760) 289-3010
Fax
(760) 863-1871
NPI assigned
Sep 14, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2021

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 18254 CA Primary

Addresses

Primary practice location

46900 Monroe St Ste 304
Indio, CA 92201-4829

Mailing address

1845 Business Center Dr Ste 127
San Bernardino, CA 92408-3434
Phone (909) 890-9030

Other practice location 1

3700 E Tachevah Dr Ste 107
Palm Springs, CA 92262-7402
Phone (760) 489-0003

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050708000236 CA Practitioner - Physical Therapist in Private Practice 5597701870 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
United Therapy Network IncorporatedGroup PAC ID 9234022369, 22 clinicians

Practice addresses (Care Compare)

3700 E Tachevah Dr
Suite 107
Palm Springs, CA 92262-7402
Phone (760) 459-0003

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18254CAMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
United Therapy Network Incorporated Physical Therapist Current Accepting new patients
United Therapy Network Incorporated Physical Therapist CurrentSince Jun 18, 2021 Accepting new patients
United Therapy Network Incorporated Physical Therapist CurrentSince Jun 18, 2021 Accepting new patients
United Therapy Network Incorporated Physical Therapist Past Accepting new patients

Locations

802 Magnolia Ave
Ste 107
Corona, CA 92879
Phone (951) 340-0070

46900 Monroe St
Ste C304
Indio, CA 92201
Phone (760) 289-3010

46900 Monroe St
Ste 304
Indio, CA 92201
Phone (760) 289-3010

3700 E Tachevah Dr
Ste 107
Palm Springs, CA 92262
Phone (760) 459-0003

1845 Business Center Dr
Ste 127
Sn Bernrdno, CA 92408
Phone (909) 890-9030

Organizations & group practices 4

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": "1631577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631577600000",
    "number": "1548930258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1845 BUSINESS CENTER DR STE 127",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083434",
            "telephone_number": "909-890-9030",
            "fax_number": "909-890-4393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "46900 MONROE ST STE 304",
            "city": "INDIO",
            "state": "CA",
            "postal_code": "922014829",
            "telephone_number": "760-289-3010",
            "fax_number": "760-863-1871"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3700 E Tachevah Dr Ste 107",
            "address_purpose": "LOCATION",
            "city": "Palm Springs",
            "state": "CA",
            "postal_code": "922627402",
            "country_code": "US",
            "telephone_number": "760-489-0003",
            "fax_number": "909-890-4393",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HUDSON",
        "first_name": "BRIAN",
        "middle_name": "JONATHAN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-14",
        "last_updated": "2021-09-14",
        "certification_date": "2021-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "18254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indio, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2021; 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.