Individual provider Active NPI

Pawel Bronkowski, DPT

  • Sports Physical Therapist
  • Boulder, CO
National Provider Identifier
1669880837
Registry record updated Dec 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physical TherapistTaxonomy code 2251S0007X
License
PTL.0015927 Issued in CO
Practice address
2150 Stadium Dr
Boulder, CO 80309
Phone
(303) 315-9900
Fax
(303) 315-9901
NPI assigned
Jul 31, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 12, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physical Therapist 2251S0007X PTL.0015927 CO Primary

Addresses

Primary practice location

2150 Stadium Dr
Boulder, CO 80309

Mailing address

5450 Western Ave
Boulder, CO 80301-2709
Phone (303) 315-9900

Other practice location 1

2837 W Irving Park Rd
Chicago, IL 60618-3624
Phone (773) 463-0249

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190204000008 CO Practitioner - Physical Therapist in Private Practice 9335361963 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boulder Community HealthGroup PAC ID 6800707233, 260 clinicians

Practice addresses (Care Compare)

2150 Stadium Dr
Boulder, CO 80309-0001
Phone (303) 315-9900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PTL.0015927COMDSports Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Community Health CurrentSince Dec 18, 2018 Accepting new patients
Boulder Community Health Current Accepting new patients
Boulder Community Health CurrentSince Dec 18, 2018 Accepting new patients
Boulder Community Health Past Accepting new patients

Locations

1755 48th St
Ste 200
Boulder, CO 80301
Phone (303) 415-7450

2150 Stadium Dr
Fl 2
Boulder, CO 80309
Phone (303) 315-9900

5450 Western Ave
Boulder, CO 80301
Phone (303) 415-4770

2150 Stadium Dr
Boulder, CO 80309
Phone (303) 315-9900

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": "1406764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544572800000",
    "number": "1669880837",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5450 WESTERN AVE",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803012709",
            "telephone_number": "303-315-9900",
            "fax_number": "303-315-9901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 STADIUM DR",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "80309",
            "telephone_number": "303-315-9900",
            "fax_number": "303-315-9901"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2837 W Irving Park Rd",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606183624",
            "country_code": "US",
            "telephone_number": "773-463-0249",
            "fax_number": "773-463-0733",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRONKOWSKI",
        "first_name": "PAWEL",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-07-31",
        "last_updated": "2018-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "CO",
            "license": "PTL.0015927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boulder, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2018; 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.