Individual provider Active NPI

Gregory Medlin, PT, DPT

  • Physical Therapist
  • Ruston, LA
National Provider Identifier
1063940542
Registry record updated Apr 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
8784 Issued in LA
Practice address
1701 Commerce St
Ruston, LA 71270-6659
Phone
(318) 224-8994
NPI assigned
May 30, 2017
Last updated
Apr 27, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 27, 2021

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 8784 LA Primary

Addresses

Primary practice location

1701 Commerce St
Ruston, LA 71270-6659

Mailing address

PO Box 2846
Ruston, LA 71273-2846
Phone (318) 224-8994

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210601000224 LA Practitioner - Physical Therapist in Private Practice 9335548023 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
Orthopaedic Clinic of MonroeGroup PAC ID 0840252698, 35 clinicians

Practice addresses (Care Compare)

707 S Vienna St
Ruston, LA 71270-5845
Phone (318) 255-4212

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8784LAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopaedic Clinic of Monroe CurrentSince Apr 1, 2022 Accepting new patients
Orthopaedic Clinic of Monroe CurrentSince Apr 1, 2022 Accepting new patients
Jackson Parish Therapy Center LLC Physical Therapist CurrentSince May 1, 2021 Accepting new patients

Locations

900 Pershing Hwy
Jonesboro, LA 71251
Phone (318) 224-8994

1501 Louisville Ave
Monroe, LA 71201
Phone 31832384514310

1500 Commerce St
Ruston, LA 71270
Phone (318) 957-5044

1701 Commerce St
Ruston, LA 71270
Phone (318) 224-8994

707 S Vienna St
Ruston, LA 71270
Phone (318) 224-3044

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, 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": "1496102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619481600000",
    "number": "1063940542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2846",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712732846",
            "telephone_number": "318-224-8994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1701 COMMERCE ST",
            "city": "RUSTON",
            "state": "LA",
            "postal_code": "712706659",
            "telephone_number": "318-224-8994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDLIN",
        "first_name": "GREGORY",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-05-30",
        "last_updated": "2021-04-27",
        "certification_date": "2021-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "LA",
            "license": "8784",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ruston, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2021; 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.