Jacob Deese, PT, DPT, ATC

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

License

P20196 Issued in NC

Practice address

13333 Dorman Rd
Pineville, NC 28134-9336

Phone

(704) 716-1024

NPI assigned

Apr 19, 2017

Last updated

Feb 9, 2021By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Breakthrough Physical Therapy IncGroup PAC ID 9234274754, 110 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Breakthrough Physical Therapy Inc

  • Physical Therapist
  • Cary, NC
  • NPI 1558598532
  Medicare reassignment Care Compare group NPD
• Breakthrough Physical Therapy

  • Physical Therapist
  • Morehead City, NC
  • NPI 1083937692
  NPD (past)

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

{
    "created_epoch": "1492560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612828800000",
    "number": "1073047759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6527 OLIVE BRANCH RD",
            "city": "MARSHVILLE",
            "state": "NC",
            "postal_code": "281039606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13333 DORMAN RD",
            "city": "PINEVILLE",
            "state": "NC",
            "postal_code": "281349336",
            "telephone_number": "704-716-1024"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6527 Olive Branch Rd",
            "address_purpose": "LOCATION",
            "city": "Marshville",
            "state": "NC",
            "postal_code": "281039606",
            "country_code": "US",
            "telephone_number": "704-624-3395",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEESE",
        "first_name": "JACOB",
        "credential": "PT, DPT, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-19",
        "last_updated": "2021-02-09",
        "certification_date": "2021-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NC",
            "license": "LAT-2888",
            "primary": false
        },
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "NC",
            "license": "P20196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caroline Grace Crilly, MS, OTR/L
• Irene N/a D'Alessandris, COTA
• Sharon Ann D'Ingillo, OTR
• Kensie F D'Orio
• Elizabeth Davidson
• Katrina Marie Deminski, RBT
• Denner Chiropractic and Performance PLLC
• Matheau James Denner, DC
• Desiree McMillan Professional Services, LLC
• Tara-Marie Devlin

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Pineville, NC
• Providers in Pineville, NC by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 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.