Individual provider Active NPI

John Feder

  • Physical Therapist
  • Broomfield, CO
National Provider Identifier
1740649102
Registry record updated Feb 15, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
9382 Issued in MT
Practice address
2716 Canossa Dr
Broomfield, CO 80020-3811
Phone
(888) 873-4221
NPI assigned
Feb 15, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 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 9382 MT Primary

Addresses

Primary practice location

2716 Canossa Dr
Broomfield, CO 80020-3811

Mailing address

2716 Canossa Dr
Broomfield, CO 80020-3811
Phone (888) 873-4221

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210610000411 CT Practitioner - Physical Therapist in Private Practice 5092115238 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rehab by Rvna LLCGroup PAC ID 2466747019, 25 clinicians
Rvnahealth, IncGroup PAC ID 7416990569, 29 clinicians

Practice addresses (Care Compare)

27 Governor St
Ridgefield, CT 06877-4608
Phone (203) 438-7862

27 Governor St
Ridgefield, CT 06877-4657
Phone (203) 438-5555

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9382MTMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Rehab by Rvna, LLC CurrentSince Mar 14, 2026 Accepting new patients
Rvnahealth, Inc. CurrentSince May 20, 2021 Accepting new patients
Rvnahealth, Inc. CurrentSince May 20, 2021 Accepting new patients

Locations

27 Governor St
Ridgefield, CT 06877
Phone (203) 438-5555

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": "1455494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455494400000",
    "number": "1740649102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2716 CANOSSA DR",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800203811",
            "telephone_number": "888-873-4221"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2716 CANOSSA DR",
            "city": "BROOMFIELD",
            "state": "CO",
            "postal_code": "800203811",
            "telephone_number": "888-873-4221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEDER",
        "first_name": "JOHN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-15",
        "last_updated": "2016-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MT",
            "license": "9382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Broomfield, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 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.