Individual provider Active NPI

Ami Bhavsar

  • Physical Therapist
  • Herndon, VA
National Provider Identifier
1659922029
Registry record updated Oct 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305213777 Issued in VA
Practice address
102 Elden St Ste 12
Herndon, VA 20170-4839
Phone
(240) 770-3505
NPI assigned
Sep 26, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X
Physical Therapist 225100000X 27585 MD
Physical Therapist 225100000X 2305213777 VA Primary

Addresses

Primary practice location

102 Elden St Ste 12
Herndon, VA 20170-4839

Mailing address

102 Elden St Ste 12
Herndon, VA 20170-4839

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191111001108 DC Practitioner - Physical Therapist in Private Practice 4981036050 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
Advanced Work Rehab Center, LLCGroup PAC ID 3870969397, 6 clinicians

Practice addresses (Care Compare)

3998 Fair Ridge Dr
Suite 100 B
Fairfax, VA 22033-2907
Phone (703) 934-0333

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
27585MDMDPhysical Therapist
2305213777VAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Work Rehab Center, LLC Physical Therapist CurrentSince Aug 1, 2022 Accepting new patients
Ati Holdings, LLC Physical Therapist CurrentSince Mar 1, 2020 Accepting new patients
Ati Holdings, LLC Physical Therapist CurrentSince Mar 1, 2020 Accepting new patients

Locations

4947 Paysphere Cir
Chicago, IL 60674
Phone (630) 783-2001

11271 New Hampshire Ave
Silver Spring, MD 20904
Phone (240) 485-1280

3998 Fair Ridge Dr
Ste 100B
Fairfax, VA 22033
Phone (703) 934-0333

Organizations & group practices 3

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": "1569456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633305600000",
    "number": "1659922029",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 ELDEN ST STE 12",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201704839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 ELDEN ST STE 12",
            "city": "HERNDON",
            "state": "VA",
            "postal_code": "201704839",
            "telephone_number": "240-770-3505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BHAVSAR",
        "first_name": "AMI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-26",
        "last_updated": "2021-10-04",
        "certification_date": "2021-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "27585",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305213777",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Herndon, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 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.