Individual provider Active NPI

Jesse Dupre, DPT

  • Physical Therapist
  • Missoula, MT
National Provider Identifier
1083046726
Registry record updated Aug 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PTP-PT-LIC5936 Issued in MT
Practice address
1705 Bow St
Missoula, MT 59801-5652
Phone
(406) 549-5283
Fax
(406) 549-5392
NPI assigned
Aug 5, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2013

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 PTP-PT-LIC5936 MT Primary

Addresses

Primary practice location

1705 Bow St
Missoula, MT 59801-5652

Mailing address

425 Stephens Ave Apt E
Missoula, MT 59801-3876
Phone (406) 431-5015

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150114002199 MT Practitioner - Physical Therapist in Private Practice 1153645452 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sapphire Physical Therapy PCGroup PAC ID 8123099603, 5 clinicians

Practice addresses (Care Compare)

1705 Bow St
Missoula, MT 59801-5652
Phone (406) 549-5283

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PTP-PT-LIC5936MTMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Sapphire Physical Therapy, PC CurrentSince Jul 1, 2013 Accepting new patients

Locations

1705 Bow St
Missoula, MT 59801
Phone (406) 219-1407

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": "1375660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375660800000",
    "number": "1083046726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 STEPHENS AVE APT E",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598013876",
            "telephone_number": "406-431-5015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1705 BOW ST",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598015652",
            "telephone_number": "406-549-5283",
            "fax_number": "406-549-5392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUPRE",
        "first_name": "JESSE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-08-05",
        "last_updated": "2013-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MT",
            "license": "PTP-PT-LIC5936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Missoula, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2013; 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.