Susan R. Brundage, DPT, MPT, OCS

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT 28782 Issued in CA

Practice address

12402 Industrial Blvd
B2
Victorville, CA 92395-5871

Phone

(760) 955-6061

Fax

(760) 955-6062

NPI assigned

Jan 20, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

California Luna Care Physical Therapy PCGroup PAC ID 9638427834, 769 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.

• California Luna Care Physical Therapy PC

  • Physical Therapist
  • Los Gatos, CA
  • NPI 1689162166
  Medicare reassignment Care Compare group NPD
• Optimal Rehab Physical Therapy Inc.

  dba Optimal Rehab Physical Therapy

  • Orthopedic Physical Therapist
  • Fresno, CA
  • NPI 1942211669
  Medicare reassignment NPD
• H.D.P.R.G., Inc

  dba Hi-Desert Physical Rehabilitation Group

  • Speech-Language Pathologist
  • Twentynine Palms, CA
  • NPI 1295886067

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1169251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484697600000",
    "number": "1821141961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24630 WASHINGTON AVE",
            "address_2": "STE. 200",
            "city": "MURRIETA",
            "state": "CA",
            "postal_code": "925626131",
            "telephone_number": "951-696-9353",
            "fax_number": "951-973-7216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12402 INDUSTRIAL BLVD",
            "address_2": "B2",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955871",
            "telephone_number": "760-955-6061",
            "fax_number": "760-955-6062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNDAGE",
        "first_name": "SUSAN",
        "middle_name": "R.",
        "credential": "DPT, MPT, OCS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-20",
        "last_updated": "2017-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT 28782",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "72157585392277A003",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "0PT287820",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I WASHINGTON",
            "identifier": "218943",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PT0287820",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Ruth Brown
• Philip Sayler Brown, M.D.
• Clinton Ellis Browning, R.D.
• Taylorvon Bruce
• Lindsey Nicole Brumett, M.S.
• Kaleb Bryant, D.C.
• Kenneth Lamont Bryant
• Melissa Brymer
• Kevin Buchanan, CADC II
• Tanis Buchananan

• Physical Therapist in Victorville, CA
• Providers in Victorville, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2017; 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.