Active NPI
Joanne Ingram, RPT
- Physical Therapist
- Victorville, CA
National Provider Identifier
1003892845
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT13147
- Practice address
- 17270 Bear Valley Rd
Ste E-105
Victorville, CA 92395-7751 - Phone
- (760) 955-6061
- Fax
- (760) 955-6062
- NPI assigned
- Dec 22, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT13147 | CA | Primary |
Addresses
Primary practice location
17270 Bear Valley Rd
Ste E-105
Victorville, CA 92395-7751
Mailing address
24630 Washington Ave
Ste 200
Murrieta, CA 92562-6177
Phone (951) 696-9353
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0PT131472 | Other | CA | MEDICARE PTAN |
| 0219113 | Other | WA | STATE OF WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT13147 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Matthew J Pautz | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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- NPI 1336120278
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1135209600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1199664000000",
"number": "1003892845",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24630 WASHINGTON AVE",
"address_2": "STE 200",
"city": "MURRIETA",
"state": "CA",
"postal_code": "925626177",
"telephone_number": "951-696-9353",
"fax_number": "951-973-7216"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17270 BEAR VALLEY RD",
"address_2": "STE E-105",
"city": "VICTORVILLE",
"state": "CA",
"postal_code": "923957751",
"telephone_number": "760-955-6061",
"fax_number": "760-955-6062"
}
],
"practiceLocations": [],
"basic": {
"last_name": "INGRAM",
"first_name": "JOANNE",
"credential": "RPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-12-22",
"last_updated": "2008-01-07",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT13147",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "0PT131472",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF WA",
"identifier": "0219113",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Victorville, CA
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.