Individual provider Active NPI

Jennifer Greene, DPT

  • Physical Therapist
  • Anaheim, CA
National Provider Identifier
1033507363
Registry record updated Apr 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT 41967 Issued in CA
Practice address
505 N Euclid St
Ste 680
Anaheim, CA 92801-5506
Phone
(714) 780-0010
Fax
(714) 780-0050
NPI assigned
Jan 9, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2015

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 PT 41967 CA Primary

Addresses

Primary practice location

505 N Euclid St
Ste 680
Anaheim, CA 92801-5506

Mailing address

200 Newport Center Dr
#213
Newport Beach, CA 92660-7501
Phone (949) 644-1322

Other identifiers 1

IdentifierTypeStateIssuer
CB228642OtherCAMEDICARE PTAN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150303001247 CA Practitioner - Physical Therapist in Private Practice 8224354675 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

505 N Euclid St
Suite 680
Anaheim, CA 92801-5509
Phone (714) 780-0010

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT 41967CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
California Rehab & Sports Therapy CurrentSince Nov 20, 2014 Accepting new patients
California Rehabilitation & Sports Therapy a California Physical Ther Physical Therapist CurrentSince Nov 20, 2014 Accepting new patients
California Rehabilitation & Sports Therapy a California Physical Ther Physical Therapist Past Accepting new patients

Locations

505 N Euclid St
Ste 680
Anaheim, CA 92801
Phone (714) 780-0010

255 E Rincon St
Ste 112
Corona, CA 92879
Phone (951) 523-8509

200 Newport Center Dr
Ste 213
Newport Beach, CA 92660
Phone (949) 644-0316

2600 Dallas Pkwy
Ste 290
Frisco, TX 75034
Phone (945) 260-0010

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1420761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429574400000",
    "number": "1033507363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 NEWPORT CENTER DR",
            "address_2": "#213",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926607501",
            "telephone_number": "949-644-1322",
            "fax_number": "949-644-0316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 N EUCLID ST",
            "address_2": "STE 680",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928015506",
            "telephone_number": "714-780-0010",
            "fax_number": "714-780-0050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREENE",
        "first_name": "JENNIFER",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-09",
        "last_updated": "2015-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT 41967",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "CB228642",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2015; 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.