Jared Boudreau, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

048553 Issued in NY

Practice address

2233 State Route 86
Medical Office Building
Saranac Lake, NY 12983

Phone

(518) 891-4141

NPI assigned

Mar 17, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mountain Land Rehabilitation LLCGroup PAC ID 9234048745, 207 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.

• Mountain Land Rehabilitation LLC

  • Physical Therapist
  • Salt Lake City, UT
  • NPI 1265549372
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1647475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647475200000",
    "number": "1033867148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2233 STATE ROUTE 86",
            "address_2": "MEDICAL OFFICE BUILDING",
            "city": "SARANAC LAKE",
            "state": "NY",
            "postal_code": "12983",
            "telephone_number": "518-891-4141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2233 STATE ROUTE 86",
            "address_2": "MEDICAL OFFICE BUILDING",
            "city": "SARANAC LAKE",
            "state": "NY",
            "postal_code": "12983",
            "telephone_number": "518-891-4141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUDREAU",
        "first_name": "JARED",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-17",
        "last_updated": "2022-03-17",
        "certification_date": "2022-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "048553",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lea Jean Bedore, CCC SLP
• Lisa Alexandra Benson, LMSW
• Nicholas W. Benware, LMSW
• James W Bevilacqua, RPH
• Jillian Bisonette
• Carrie Marie Bradley
• Denice Ann Brady, RPH
• Jessica Brockway
• Matthew Raymond Brown, PHARM D
• Diane M. Bryjak, MFT

• Physical Therapist in Saranac Lake, NY
• Providers in Saranac Lake, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2022; 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.