Jerry Clifton Ivy, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

2125 Issued in OR

Practice address

4 S Main St Ste B
Joseph, OR 97846-8434

Phone

(541) 432-1480

Fax

(541) 432-1481

NPI assigned

Apr 6, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Winding Waters Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • Enterprise, OR
  • NPI 1922475219

  OR

  Medicare reassignment NPD
• Winding Waters Medical Clinic

  • Community/Retail Pharmacy
  • Wallowa, OR
  • NPI 1114631322
  NPD
• Winding Waters Medical Clinic

  • Federally Qualified Health Center (FQHC)
  • Enterprise, OR
  • NPI 1518426493
  NPD
• Corvallis Sport and Spine Physical Therapy Inc

  • Physical Therapist
  • Albany, OR
  • NPI 1477991149
  NPD (past)
• Mountain Valley Therapy, Inc

  • Physical Therapist
  • La Grande, OR
  • NPI 1659353035
  NPD (past)

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579132800000",
    "number": "1093778680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 355",
            "city": "ENTERPRISE",
            "state": "OR",
            "postal_code": "978280355",
            "telephone_number": "541-426-4870",
            "fax_number": "541-426-4872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 S MAIN ST STE B",
            "city": "JOSEPH",
            "state": "OR",
            "postal_code": "978468434",
            "telephone_number": "541-432-1480",
            "fax_number": "541-432-1481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVY",
        "first_name": "JERRY",
        "middle_name": "CLIFTON",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-06",
        "last_updated": "2020-01-16",
        "certification_date": "2020-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OR",
            "license": "2125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "016852",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Traci M. Frye, R.N., F.N.P.
• Amy Jacqueline Gulzow, LMT
• Charles Jeffrey Harman, LPC
• Healthcare Naturally
• Nicole Margaret Hennes
• Joseph Charter School
• Tammy Lynn Kruger, RN
• Crystal Renea Locke, LMT
• Laurie E McNall, RN
• Carrise Murray, CSWA, MSW

• All providers in Joseph, OR
• Physical Therapist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.