Individual provider Active NPI

Cody Tsevdos

  • Physical Therapist
  • Springfield, MA
National Provider Identifier
1790330355
Registry record updated Aug 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
24336 Issued in MA
Practice address
1150 Hall of Fame Ave Ste 3
Springfield, MA 01105-2532
Phone
(413) 241-8900
Fax
(413) 241-8901
NPI assigned
Aug 9, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2019

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 24336 MA Primary

Addresses

Primary practice location

1150 Hall of Fame Ave Ste 3
Springfield, MA 01105-2532

Mailing address

576 Broadhollow Road
Suite Pro Ex
Melville, NY 11747
Phone (631) 359-5859

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240311001110 PA Practitioner - Physical Therapist in Private Practice 9537497060 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Progress Physical Therapy LLCGroup PAC ID 1951530849, 430 clinicians

Practice addresses (Care Compare)

8015 Frankford Ave
Philadelphia, PA 19136-2736
Phone (215) 338-8900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
24336MAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
FCC Enterprises LLC Physical Therapist CurrentSince Jan 28, 2024 Accepting new patients
Progress Physical Therapy LLC Physical Therapist CurrentSince Feb 15, 2025 Accepting new patients

Locations

29 Keller Ave
Ste 102
Lancaster, PA 17601
Phone (717) 740-2678

155 S Main Rd
Mountain Top, PA 18707
Phone (570) 474-5088

33 N Main St
Ste 100
Pittston, PA 18640
Phone (570) 208-2787

52 S Main St
Wilkes Barre, PA 18701
Phone (570) 307-2775

40 E Northampton St
Wilkes Barre, PA 18701

Organizations & group practices 2

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": "1565308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565308800000",
    "number": "1790330355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "576 BROADHOLLOW ROAD",
            "address_2": "SUITE PRO EX",
            "city": "MELVILLE",
            "state": "NY",
            "postal_code": "11747",
            "telephone_number": "631-359-5859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 HALL OF FAME AVE STE 3",
            "city": "SPRINGFIELD",
            "state": "MA",
            "postal_code": "011052532",
            "telephone_number": "413-241-8900",
            "fax_number": "413-241-8901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TSEVDOS",
        "first_name": "CODY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-09",
        "last_updated": "2019-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "24336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2019; 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.