Individual provider Active NPI

Brandon Nan

  • Physical Therapist
  • Modesto, CA
National Provider Identifier
1629390638
Registry record updated Feb 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT36432 Issued in CA
Practice address
4318 Spyres Way
Modesto, CA 95356-9259
Phone
(209) 576-0710
Fax
(209) 576-7283
NPI assigned
Feb 17, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2010

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 PT36432 CA Primary

Addresses

Primary practice location

4318 Spyres Way
Modesto, CA 95356-9259

Mailing address

4318 Spyres Way
Modesto, CA 95356-9259
Phone (209) 576-0710

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121010000017 CA Practitioner - Physical Therapist in Private Practice 7113176009 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Golden Bear Physical Therapy Sports Injury Center IncGroup PAC ID 2961423082, 85 clinicians

Practice addresses (Care Compare)

1906 Vista del Lago Dr
Suite a
Valley Springs, CA 95252-9700
Phone (209) 772-0848

Merit-based Incentive Payment System (MIPS)

Final score
67.73 of 100Reported as group
Quality
41.21
Improvement activities
40
Cost
83.55

Merit-based Incentive Payment System (MIPS)

Final score
75.98 of 100Reported as group
Quality
55.25
Improvement activities
40
Cost
79.61

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Golden Bear Physical Therapy Sports Injury Center, Inc Physical Therapist CurrentSince Sep 14, 2012 Accepting new patients
Gold Country Therapies, Inc CurrentSince Jan 1, 2015 Accepting new patients
Golden Bear Physical Therapy Current Accepting new patients
Body in Balance Physical Therapy, Inc. Physical Therapist CurrentSince Feb 23, 2021 Accepting new patients
Two Trees Physical Therapy & Wellness Inc Physical Therapist PastSince Dec 14, 2021 Accepting new patients
Pinnacle Physical Therapy PC PastSince Jun 8, 2021 Accepting new patients
Pair & Marotta Physical Therapy, Inc. PastSince Oct 23, 2021 Accepting new patients
Greater Lewisville Therapy Center Inc Physical Therapist PastSince Jul 15, 2021 Accepting new patients
Physiomotion Physical Therapy, Inc. Physical Therapist PastSince Aug 8, 2016 Accepting new patients
Northwest Rehabilitation Associates, Inc. Physical Therapist PastSince Apr 28, 2021 Accepting new patients
Inspire Physical & Hand Therapy Spokane Inc. P.S. Physical Therapist PastSince Jul 16, 2021 Accepting new patients
Bodycentral Physical Therapy PC PastSince Mar 29, 2021 Accepting new patients
Optm Physical Therapy of Saratoga, Inc. Physical Therapist PastSince Jun 8, 2021 Accepting new patients
Paulseth and Associates Physical Therapy Inc. Physical Therapist PastSince Dec 28, 2021 Accepting new patients
Prosport Physical Therapy Professionals Inc Physical Therapist PastSince Oct 17, 2022 Accepting new patients

Locations

2222 Francisco Dr
Ste 120
El Dorado Hills, CA 95762
Phone (916) 235-4071

222 Acacia St
Fairfield, CA 94533
Phone (707) 421-0418

4080 N Cedar Ave
Fresno, CA 93726
Phone (559) 222-7497

4318 Spyres Way
Modesto, CA 95356
Phone (209) 284-4910

1518 Coffee Rd
Ste I
Modesto, CA 95355

1335 Coffee Rd
Ste 200
Modesto, CA 95355
Phone (209) 576-1946

1222 W Colony Rd
Ste 130
Ripon, CA 95366
Phone (209) 624-1288

1586 Constitution Blvd
Salinas, CA 93905
Phone (831) 276-0565

855 S Tracy Blvd
Tracy, CA 95376
Phone (209) 627-1383

1009 Alamo Dr
Vacaville, CA 95687
Phone (707) 689-5025

1906 Vista del Lago Dr
Ste A
Valley Springs, CA 95252
Phone (209) 772-0848

Organizations & group practices 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1266364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266364800000",
    "number": "1629390638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4318 SPYRES WAY",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953569259",
            "telephone_number": "209-576-0710",
            "fax_number": "209-576-7283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4318 SPYRES WAY",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953569259",
            "telephone_number": "209-576-0710",
            "fax_number": "209-576-7283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NAN",
        "first_name": "BRANDON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-02-17",
        "last_updated": "2010-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT36432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Modesto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2010; 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.