Individual provider Active NPI

Philip Wayne Grider

  • Physical Therapist
  • Newcastle, OK
National Provider Identifier
1770964298
Registry record updated Jun 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
4983 Issued in OK
Practice address
3699 NW 32ND St
Newcastle, OK 73065-6559
Phone
(405) 387-5520
Fax
(405) 387-5404
NPI assigned
Jun 10, 2015
Last updated
Jun 10, 2015By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 10, 2015

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 4983 OK Primary

Addresses

Primary practice location

3699 NW 32ND St
Newcastle, OK 73065-6559

Mailing address

3699 NW 32ND St
Newcastle, OK 73065-6559
Phone (405) 387-5520

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150806011982 OK Practitioner - Physical Therapist in Private Practice 8123332970 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
PTMS 3.0 LLCGroup PAC ID 2365768231, 115 clinicians

Practice addresses (Care Compare)

2100 N Eastern Ave
Suite 4 PTC East Moore
Moore, OK 73160-5684
Phone (405) 676-6030

440 Merchant Dr
Norman, OK 73069-6470
Phone (405) 809-8713

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4983OKMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
PTMS 3.0, LLC Physical Therapist CurrentSince Jul 20, 2015 Accepting new patients
PTMS 3.0, LLC Physical Therapist Current Accepting new patients
PTMS 3.0, LLC Physical Therapist CurrentSince Jul 20, 2015 Accepting new patients

Locations

3699 NW 32nd St
Newcastle, OK 73065
Phone (405) 387-5520

307 N Main St
Noble, OK 73068
Phone (405) 809-8700

440 Merchant Dr
Norman, OK 73069
Phone (405) 579-1600

440 Merchant Dr
Ste 200
Norman, OK 73069

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1433894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433894400000",
    "number": "1770964298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3699 NW 32ND ST",
            "city": "NEWCASTLE",
            "state": "OK",
            "postal_code": "730656559",
            "telephone_number": "405-387-5520",
            "fax_number": "405-387-5404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3699 NW 32ND ST",
            "city": "NEWCASTLE",
            "state": "OK",
            "postal_code": "730656559",
            "telephone_number": "405-387-5520",
            "fax_number": "405-387-5404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRIDER",
        "first_name": "PHILIP",
        "middle_name": "WAYNE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-06-10",
        "last_updated": "2015-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OK",
            "license": "4983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Newcastle, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2015; 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.