Individual provider Active NPI

James Ryan Bogdanovich, DPT

  • Physical Therapist
  • Riverside, CA
National Provider Identifier
1922864222
Registry record updated Feb 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT305629 Issued in CA
Practice address
3191 Mission Inn Ave Ste B
Riverside, CA 92507-4188
Phone
(951) 684-2874
Fax
(951) 684-2980
NPI assigned
Feb 23, 2024
Last updated
Feb 23, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2024

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 PT305629 CA Primary

Addresses

Primary practice location

3191 Mission Inn Ave Ste B
Riverside, CA 92507-4188

Mailing address

3191 Mission Inn Ave Ste B
Riverside, CA 92507-4188
Phone (951) 684-2874

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240313003959 CA Practitioner - Physical Therapist in Private Practice 0749626612 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3191 Mission Inn Ave
Suite B
Riverside, CA 92507-4188
Phone (951) 684-2874

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT305629CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Marketplace Physical Therapy Inc, a Professional Corporation Physical Therapist CurrentSince Feb 29, 2024 Accepting new patients
Total Wellness Inc Physical Therapist Past Accepting new patients

Locations

14682 Central Ave
Chino, CA 91710
Phone (909) 217-3664

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": "1708646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708646400000",
    "number": "1922864222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3191 MISSION INN AVE STE B",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925074188",
            "telephone_number": "951-684-2874",
            "fax_number": "951-684-2980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3191 MISSION INN AVE STE B",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925074188",
            "telephone_number": "951-684-2874",
            "fax_number": "951-684-2980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOGDANOVICH",
        "first_name": "JAMES",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-02-23",
        "last_updated": "2024-02-23",
        "certification_date": "2024-02-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT305629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2024; 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.