Individual provider Active NPI

Philip Van Dyke, DPT

  • Physical Therapist
  • Greenville, SC
National Provider Identifier
1629522578
Registry record updated Aug 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
8288 Issued in SC
Practice address
200 Patewood Dr
Ste C150
Greenville, SC 29615-3593
Phone
(864) 454-0904
Fax
(864) 454-0905
NPI assigned
Aug 9, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2016

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 8288 SC Primary

Addresses

Primary practice location

200 Patewood Dr
Ste C150
Greenville, SC 29615-3593

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230913003105 TX Practitioner - Physical Therapist in Private Practice 3476841305 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
84.26 of 100Reported as group
Quality
89.74
Improvement activities
40
Cost
61.81

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Powerback Rehabilitation LLC Physical Therapist CurrentSince Nov 28, 2023 Accepting new patients
Texas Luna Care Physical Therapy LLC Physical Therapist CurrentSince Aug 30, 2023 Accepting new patients
Powerback Rehabilitation LLC Physical Therapist CurrentSince Nov 28, 2023 Accepting new patients
Prisma Health University Medical Group Past Accepting new patients

Locations

7801 N Richland Blvd
North Richlnd Hls, TX 76180
Phone (469) 609-9044

180 State St
Ste 225
Southlake, TX 76092
Phone (682) 429-7066

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": "1470700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470700800000",
    "number": "1629522578",
    "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": "630-296-2223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PATEWOOD DR",
            "address_2": "STE C150",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153593",
            "telephone_number": "864-454-0904",
            "fax_number": "864-454-0905"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DYKE",
        "first_name": "PHILIP",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-09",
        "last_updated": "2016-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "8288",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2016; 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.