Individual provider Active NPI

John Mitrovic, PT SCS ATC CSCS

  • Physical Therapist
  • Williamsburg, VA
National Provider Identifier
1730142639
Registry record updated Apr 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2305003424 Issued in VA
Practice address
4125 Ironbound Rd Ste 100
Williamsburg, VA 23188-2666
Phone
(757) 220-8383
Fax
(757) 253-7833
NPI assigned
Apr 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2018

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 2305003424 VA Primary

Addresses

Primary practice location

4125 Ironbound Rd Ste 100
Williamsburg, VA 23188-2666

Mailing address

PO Box 69030
Baltimore, MD 21264-9030
Phone (757) 873-2302

Other identifiers 4

IdentifierTypeStateIssuer
8928649MedicaidVA
192935OtherVABCBS PHYSICAL THERAPY
4460951OtherAETNA
650003973OtherVARAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
88.16 of 100Reported as group
Quality
85.78
Promoting interoperability
99
Improvement activities
40
Cost
75.6

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Tidewater Physical Therapy, LLC Physical Therapist Current Accepting new patients
Tidewater Physical Therapy, LLC Physical Therapist CurrentSince Feb 25, 1999 Accepting new patients
Tidewater Physical Therapy, LLC Physical Therapist CurrentSince Jan 1, 1996 Accepting new patients

Locations

10128 W Broad St
Bldg Iii
Glen Allen, VA 23060
Phone (804) 217-9210

771 Pilot House Dr
#A
Newport News, VA 23606
Phone (757) 873-2302

12494 Warwick Blvd
Newport News, VA 23606
Phone (804) 217-9210

4125 Ironbound Rd
Ste 100
Williamsburg, VA 23188
Phone (757) 220-8383

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": "1144713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524787200000",
    "number": "1730142639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 69030",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212649030",
            "telephone_number": "757-873-2302",
            "fax_number": "757-873-2306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4125 IRONBOUND RD STE 100",
            "city": "WILLIAMSBURG",
            "state": "VA",
            "postal_code": "231882666",
            "telephone_number": "757-220-8383",
            "fax_number": "757-253-7833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITROVIC",
        "first_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "PT SCS ATC CSCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-11",
        "last_updated": "2018-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "VA",
            "license": "2305003424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8928649",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PHYSICAL THERAPY",
            "identifier": "192935",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4460951",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "650003973",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.