Individual provider Active NPI

Jeremy Albert Dye, M.P.T.

  • Physical Therapist
  • Hayden, ID
National Provider Identifier
1053534461
Registry record updated Jun 5, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT2429 Issued in ID
Practice address
1172 W Hayden Ave
Hayden, ID 83835-8700
Phone
(208) 773-8111
Fax
(208) 773-8385
NPI assigned
Apr 11, 2007
Last updated
Jun 5, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT2429 ID Primary
Physical Therapist 225100000X PT25530 CA

Addresses

Primary practice location

1172 W Hayden Ave
Hayden, ID 83835-8700

Mailing address

1917 N Lakewood Dr
Coeur D Alene, ID 83814-2634
Phone (208) 664-8194

Other identifiers 1

IdentifierTypeStateIssuer
PT2429OtherIDBUREAU OF OCCUPATIONAL LICENSES

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081014000617 ID Practitioner - Physical Therapist in Private Practice 3173691458 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shellman Inc PAGroup PAC ID 4981592938, 45 clinicians

Practice addresses (Care Compare)

1172 W Hayden Ave
Hayden, ID 83835-8700
Phone (208) 762-3332

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT25530CAMDPhysical Therapist
PT2429IDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Shellman Inc PA Physical Therapist CurrentSince Aug 15, 2008 Accepting new patients

Locations

1917 N Lakewood Dr
Coeur D Alene, ID 83814
Phone (208) 664-8194

1172 W Hayden Ave
Hayden, ID 83835
Phone (208) 762-3332

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528156800000",
    "number": "1053534461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1917 N LAKEWOOD DR",
            "city": "COEUR D ALENE",
            "state": "ID",
            "postal_code": "838142634",
            "telephone_number": "208-664-8194",
            "fax_number": "208-667-1847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1172 W HAYDEN AVE",
            "city": "HAYDEN",
            "state": "ID",
            "postal_code": "838358700",
            "telephone_number": "208-773-8111",
            "fax_number": "208-773-8385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DYE",
        "first_name": "JEREMY",
        "middle_name": "ALBERT",
        "credential": "M.P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-11",
        "last_updated": "2018-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT2429",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT25530",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUREAU OF OCCUPATIONAL LICENSES",
            "identifier": "PT2429",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hayden, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 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.