Jayachandra Bommareddy

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501013421 Issued in MI

Practice address

17001 17 Mile Rd
Clinton Township, MI 48038-2801

Phone

(586) 286-7100

NPI assigned

Mar 19, 2018

Last updated

Mar 19, 2018By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Powerback Rehabilitation LLCGroup PAC ID 2365359932, 600 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Powerback Rehabilitation LLC

  dba Powerback Rehabilitation

  • Physical Therapist
  • Shelby Township, MI
  • NPI 1912226366
  Medicare reassignment Care Compare group NPD
• Powerback Rehabilitation LLC

  dba Powerback Rehabilitation

  • Physical Therapist
  • Woodbridge, VA
  • NPI 1790640761
  NPD

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

{
    "created_epoch": "1521417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521417600000",
    "number": "1790289494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3198 FANTAIL DR",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483094292",
            "telephone_number": "510-565-4554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17001 17 MILE RD",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480382801",
            "telephone_number": "586-286-7100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOMMAREDDY",
        "first_name": "JAYACHANDRA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-03-19",
        "last_updated": "2018-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501013421",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dana Boggia, LLPC
• Kai' K.a.B Bohlinger, LLMSW
• Tena Bolanca-Trajkovic, AGACNP-BC
• Tyler Robert Bolda
• Tanya Bolos
• Stephanie M Bommarito, SPEECH THERAPIST
• Shelley Galasso Bonanno, MA LLP
• Bone and Joint Rehabilitation Center, LLC
• Devone Booker
• Nicholas Boris

• Physical Therapist in Clinton Township, MI
• Providers in Clinton Township, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 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.