Ketki Ajit Raktavan, MPT

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

27954 Issued in MD

Practice address

12200 Annapolis Rd Ste 119
Glenn Dale, MD 20769-9182

Phone

(301) 805-8005

Fax

(301) 805-5004

NPI assigned

Oct 13, 2020

Last updated

Jun 25, 2024By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in DC, IL2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Athletic and Therapeutic Institute of Naperville, LLCGroup PAC ID 8325014020, 251 clinicians

Athletic and Therapeutic Institute of Bourbonnais, LLCGroup PAC ID 4183692577, 171 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

85.61 of 100Reported as group

Quality

90

Improvement activities

40

Cost

70.36

Merit-based Incentive Payment System (MIPS)

Final score

86.49 of 100Reported as group

Quality

90

Improvement activities

40

Cost

73.3

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.

• Athletic and Therapeutic Institute of Bourbonnais, LLC

  dba ATI Physical Therapy

  • Physical Therapist
  • Bourbonnais, IL
  • NPI 1861503542

  Orthopedic

  Medicare reassignment Care Compare group NPD
• Athletic and Therapeutic Institute of Naperville LLC

  dba ATI Physical Therapy

  • Physical Therapist
  • Aurora, IL
  • NPI 1023129681

  Orthopedic

  Medicare reassignment Care Compare group NPD
• Sports Pro Physical Therapy LLC

  • Physical Therapist
  • Upper Marlboro, MD
  • NPI 1285611608

  DC

  Medicare reassignment NPD
• Athletic & Therapeutic Institute of Bourbonnais, LLC

  dba ATI Physical Therapy

  • Physical Therapist
  • Minooka, IL
  • NPI 1083937056

  Orthopedic

  NPD
• Athletic and Therapeutic Institute of Bourbonnais, LLC

  • Durable Medical Equipment & Medical Supplies
  • Columbia, IL
  • NPI 1124766696

  Orthopedic

  NPD
• Athletic and Therapeutic Institute of Naperville, LLC

  • Durable Medical Equipment & Medical Supplies
  • Hazel Crest, IL
  • NPI 1043952641
  NPD
• Sports Pro Physical Therapy LLC.

  • Physical Therapist
  • Glenn Dale, MD
  • NPI 1932576378
  NPD (past)

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

{
    "created_epoch": "1602547200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719273600000",
    "number": "1992303820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12200 ANNAPOLIS RD STE 119",
            "city": "GLENN DALE",
            "state": "MD",
            "postal_code": "207699182",
            "telephone_number": "301-805-8005",
            "fax_number": "301-805-5004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAKTAVAN",
        "first_name": "KETKI",
        "middle_name": "AJIT",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-13",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "MD",
            "license": "27954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Proactive Healthcare Services LLC
• Proactive Healthcare Services LLC
• Glenda Prudencio, PA-C
• Jessica Pryor, PA-C
• Quantum Rehabilitation Medicine
• Donald Reese
• Rehabit Smartcenter, LLC
• Remediez LLC
• Ricardo O Pyfrom MD PA
• Nadine Rikam Moudji

• Orthopedic Physical Therapist in Glenn Dale, MD
• Providers in Glenn Dale, MD by specialty
• Orthopedic Physical Therapist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.