Jack Anthony Spatafore, DPT/MS

Primary specialty

SpecialistTaxonomy code 174400000X

License

002038 Issued in WV

Practice address

306 W Main St
Bridgeport, WV 26330-1751

Phone

(304) 842-3137

Fax

(304) 842-3138

NPI assigned

Jun 28, 2005

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

Other identifiers 9

Medicare fee-for-service enrollment

Enrolled in WV

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2000

Medicare assignment

May accept Medicare assignment

Group practices

Bridgeport Physical Therapy Services, Inc.Group PAC ID 3678501855, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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 and National Provider Directory roles.

• Bridgeport Physical Therapy Services, Inc.

  • Specialist
  • Bridgeport, WV
  • NPI 1912086158
  Medicare reassignment Care Compare group NPD
• Bridgeport Physical Therapy Services, Inc.

  • Physical Therapist
  • Bridgeport, WV
  • NPI 1588146658
  NPD

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

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237939200000",
    "number": "1093711657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 W MAIN ST",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263301751",
            "telephone_number": "304-842-3137",
            "fax_number": "304-842-3138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 W MAIN ST",
            "city": "BRIDGEPORT",
            "state": "WV",
            "postal_code": "263301751",
            "telephone_number": "304-842-3137",
            "fax_number": "304-842-3138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPATAFORE",
        "first_name": "JACK",
        "middle_name": "ANTHONY",
        "credential": "DPT/MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-28",
        "last_updated": "2009-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WV",
            "license": "002038",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WV",
            "license": "002038",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WV WORKERS' COMPENSATION",
            "identifier": "01071873100",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMWA",
            "identifier": "1382862",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7305012-001",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PLAN",
            "identifier": "WV51916B",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "701615",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "650023875",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "010718731004",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ASSURANCE",
            "identifier": "135810",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTIMUM CHOICE",
            "identifier": "398789",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jeremy B Soule, MD
• Melanie D. Soule, NP
• Sound Mind Therapeutic Center, LLC
• Jasmine Necole Southern
• Andrew E Spatafore, MPT
• Lori Spatafore, RPH
• Valerie Speller, CRNA
• Courtnie Danielle Spencer, LMT
• Sydney Belle Spiker
• Hannah E. Squires

• Specialist in Bridgeport, WV
• Providers in Bridgeport, WV by specialty
• Specialist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2009; 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.