Jeremy Mitchell
Individual provider Active NPI Orthopedic Physical Therapist · Lompoc, CA
NPI 1003215682 · NPPES record last updated Nov 19, 2014
Key facts
- NPI
- 1003215682
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthopedic Physical Therapist 2251X0800X
- License
- 10986PT (AZ)
- Practice address
- 805 E Walnut Ave
Lompoc, CA 93436-7027 - Phone
- (805) 735-3714
- NPI assigned
- Aug 19, 2014
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 5
-
Kenneth Daniel Channer, D.P.T.
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2016
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1111 S Broadway
Suite 201
Santa Maria, CA 93454-6682
Merit-based Incentive Payment System (MIPS)
- Final score
- 21.38 of 100
- Quality
- 0
- Improvement activities
- 0
- Cost
- 71.26
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150204000419 | CA | Practitioner - Physical Therapist in Private Practice | 8123343621 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10986PT | AZ | MD | Orthopedic Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beck and Cale Physical Therapy of Santa Maria | Past | Accepting new patients | |
| Carnahan Therapy the Work Center, Inc. | Past |
Accepting new patients | |
| Coastal Hand & Occupational Therapy Inc | Orthopedic | Past |
Accepting new patients |
| Coastal Hand and Occupational Therapy | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | 10986PT | AZ | Yes |
Addresses
Primary practice location
805 E Walnut Ave
Lompoc, CA 93436-7027
Mailing address
259 Riverdale CT Apt 236
Camarillo, CA 93012-7775
Phone (805) 478-7263
Other providers in Lompoc, CA
- Oboli Minasse
- Alexia Yaire Miranda
- Mission Orthopedics Surgery and Sports Medicine
- Damani Muata Mitchell
- James Edward Mitchell
- Shereen Mizany
- Haley Mogensen
- Daniel S Moghadam
- Karim Ibrahim Mohamed
- Kiele Teresa Mohre
All providers in Lompoc, CA · Orthopedic Physical Therapist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 19, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.