Active NPI
Brian Ferguson, ASSOCIATES
- Physical Therapy Assistant
- Santa Rosa, CA
National Provider Identifier
1578286373
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 50328
- Practice address
- 300 Fountaingrove Pkwy
Santa Rosa, CA 95403-5720 - Phone
- (707) 566-8600
- NPI assigned
- Sep 26, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 50328 | CA | Primary |
Addresses
Primary practice location
300 Fountaingrove Pkwy
Santa Rosa, CA 95403-5720
Mailing address
9892 Hamlet CT S
Cottage Grove, MN 55016-4833
Phone (612) 876-8874
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 50328 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664150400000",
"number": "1578286373",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9892 HAMLET CT S",
"city": "COTTAGE GROVE",
"state": "MN",
"postal_code": "550164833",
"telephone_number": "612-876-8874"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 FOUNTAINGROVE PKWY",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954035720",
"telephone_number": "707-566-8600"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FERGUSON",
"first_name": "BRIAN",
"credential": "ASSOCIATES",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-09-26",
"last_updated": "2022-09-26",
"certification_date": "2022-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "CA",
"license": "50328",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.