Individual provider Active NPI

Grant Trembly, DPT

  • Physical Therapist
  • Derby, KS
National Provider Identifier
1902209364
Registry record updated May 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
608 N Mulberry Rd
Derby, KS 67037-3532
Phone
(316) 202-0996
Fax
(316) 202-0997
NPI assigned
Sep 30, 2014
Last updated
May 6, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 18470 NC
Physical Therapist 225100000X KS Primary

Addresses

Primary practice location

608 N Mulberry Rd
Derby, KS 67037-3532

Mailing address

200 W Douglas Ave Ste 1040
Wichita, KS 67202-3017
Phone (316) 263-0003

Other practice location 1

401 Attain St Ste 121
Fuquay Varina, NC 27526-2702
Phone (919) 557-3017

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS, NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190606000072 KS Practitioner - Physical Therapist in Private Practice 0749513737 Reassigns benefits to 1 organization
I20220202002852 NC Practitioner - Physical Therapist in Private Practice 0749513737

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Physical Therapy and Sports Performance LLCGroup PAC ID 6406229095, 4 clinicians

Practice addresses (Care Compare)

1909 N 14TH Ave
Suite C PT Works
Dodge City, KS 67801-2365
Phone (620) 338-8633

Merit-based Incentive Payment System (MIPS)

Final score
83.06 of 100Reported as group
Quality
61.01
Promoting interoperability
100
Improvement activities
40
Cost
82.52

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18470NCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Physical Therapy and Sports Performance, LLC Physical Therapist CurrentSince Jun 1, 2024 Accepting new patients
Advanced PT, LLC PastSince May 14, 2019 Accepting new patients

Locations

1909 N 14th Ave
Ste C
Dodge City, KS 67801
Phone (620) 338-8633

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, 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": "1412035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1557100800000",
    "number": "1902209364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W DOUGLAS AVE STE 1040",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672023017",
            "telephone_number": "316-263-0003",
            "fax_number": "316-263-1241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 N MULBERRY RD",
            "city": "DERBY",
            "state": "KS",
            "postal_code": "670373532",
            "telephone_number": "316-202-0996",
            "fax_number": "316-202-0997"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "401 Attain St Ste 121",
            "address_purpose": "LOCATION",
            "city": "Fuquay Varina",
            "state": "NC",
            "postal_code": "275262702",
            "country_code": "US",
            "telephone_number": "919-557-3017",
            "fax_number": "919-557-3748",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TREMBLY",
        "first_name": "GRANT",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-30",
        "last_updated": "2019-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "18470",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KS",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Derby, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 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.