NICOLE LYNN BURGESS (PT) – Physical Therapist, NPI 1194914648
Physical Therapist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
3,459 PHYSICAL THERAPIST IN PRIVATE PRACTICE in MI
Provider Addresses for NICOLE LYNN BURGESS (PT)
451 Health Pkwy
Paw Paw, MI 490798242
Phone: (269) 657-1490
Fax: (269) 657-1444
Type: Location
53880 Carmichael Dr
South Bend, IN 466351567
Phone: (574) 247-9441
Type: Location
451, Health Parkway, Paw Paw, Paw Paw Township, Van Buren County, Michigan, 49079, United States
PAW PAW, MI 490798242
Phone: (269) 657-1490
Fax: (269) 657-1444
Type: Mailing
183 PEACE BLVD
SAINT JOSEPH, MI 490859146
Phone: (269) 408-1636
Fax: (269) 429-6451
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-02-19
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20250219001993 | I | Physical Therapist In Private Practice | MI | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 49079)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Physical Therapist In Private Practice | IN | |
| Nurse Practitioner | MI | |
| Physical Therapist In Private Practice | MI | |
| - | CA | |
| Orthopedic Surgery | MI | |
| - | MI | |
| - | MI | |
| Orthopedic Surgery | MI | |
| Orthopedic Surgery | MI | |
| Physical Therapist In Private Practice | IL |
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