Active NPI
Jessica Stipp, DPT
- Physical Therapist
- West Lafayette, IN
National Provider Identifier
1073151619
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05011261A
- Practice address
- 1700 Lindberg Rd
West Lafayette, IN 47906-7317 - Phone
- (765) 464-5600
- NPI assigned
- Dec 13, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 05011261A | IN | Primary |
Addresses
Primary practice location
1700 Lindberg Rd
West Lafayette, IN 47906-7317
Mailing address
PO Box 4699
Lafayette, IN 47903-4699
Phone (765) 446-5417
Other practice location 1
307 Sagamore Pkwy W Ste 400
West Lafayette, IN 47906-1500
Phone (765) 463-2200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 300033967 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2013
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
PO Box
Suite 4699
Lafayette, IN 47903-4699
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1576195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1652054400000",
"number": "1073151619",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4699",
"city": "LAFAYETTE",
"state": "IN",
"postal_code": "479034699",
"telephone_number": "765-446-5417",
"fax_number": "765-446-5317"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1700 LINDBERG RD",
"city": "WEST LAFAYETTE",
"state": "IN",
"postal_code": "479067317",
"telephone_number": "765-464-5600"
}
],
"practiceLocations": [
{
"address_1": "307 Sagamore Pkwy W Ste 400",
"address_purpose": "LOCATION",
"city": "West Lafayette",
"state": "IN",
"postal_code": "479061500",
"country_code": "US",
"telephone_number": "765-463-2200",
"fax_number": "765-463-3625",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "STIPP",
"first_name": "JESSICA",
"credential": "DPT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-12-13",
"last_updated": "2022-05-09",
"certification_date": "2022-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05011261A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "300033967",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Lafayette, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- 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.