Jake Fellow, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT295188 Issued in CA

Practice address

11848 Bernardo Plaza CT Ste 100
San Diego, CA 92128-2417

Phone

(858) 217-2496

NPI assigned

Aug 15, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Asis Physical Therapy IncGroup PAC ID 1951455765, 16 clinicians

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Asis Physical Therapy, Inc.

  • Physical Therapist
  • San Diego, CA
  • NPI 1023269222
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1534291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534291200000",
    "number": "1033699541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16631 ORCHARD BEND RD",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920641713",
            "telephone_number": "909-260-7739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11848 BERNARDO PLAZA CT STE 100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921282417",
            "telephone_number": "858-217-2496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FELLOW",
        "first_name": "JAKE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-15",
        "last_updated": "2018-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "PT295188",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT295188",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "295188",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erika Lyniece Felkins
• Iren Fellegvari, PSY.D, MFT, CADCII,
• Benjamin Isaac Felleman, PH.D.
• Janelle Fellenz
• Karli Fellmann
• John E. Fellow, M.D.
• David Fellows
• Olivia Fellus, L.A.C, DIPL.OM
• Christina Felonis
• Joseph Felt, PHARMD

• Physical Therapist in San Diego, CA
• Providers in San Diego, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2018; 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.