Individual provider Active NPI

Jerison D. Speer, PT

  • Physical Therapist
  • Columbus, GA
National Provider Identifier
1063452589
Registry record updated Jan 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT008252 Issued in GA
Practice address
122 Enterprise CT Ste E
Columbus, GA 31904-3651
Phone
(706) 507-5917
Fax
(706) 887-4818
NPI assigned
Jun 7, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2019

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 PTH4454 AL
Physical Therapist 225100000X PT008252 GA Primary

Addresses

Primary practice location

122 Enterprise CT Ste E
Columbus, GA 31904-3651

Mailing address

122 Enterprise CT Ste E
Columbus, GA 31904-3651
Phone (706) 507-5917

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150724011655 GA Practitioner - Physical Therapist in Private Practice 4981653276 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Medical College of Georgia School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

122 Enterprise CT
Suite E
Columbus, GA 31904-3651
Phone (706) 718-8695

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PTH4454ALMDPhysical Therapist
PT008252GAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Victory Rehabilitation LLC Physical Therapist CurrentSince May 1, 2018 Accepting new patients

Locations

122 Enterprise Ct
Ste E
Columbus, GA 31904
Phone (706) 507-5917

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.

NPI Registry JSON

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546819200000",
    "number": "1063452589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 ENTERPRISE CT STE E",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319043651",
            "telephone_number": "706-507-5917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 ENTERPRISE CT STE E",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319043651",
            "telephone_number": "706-507-5917",
            "fax_number": "706-887-4818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPEER",
        "first_name": "JERISON",
        "middle_name": "D.",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-07",
        "last_updated": "2019-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AL",
            "license": "PTH4454",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT008252",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2019; 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.