Individual provider Active NPI

Jared Francis Yankovich

  • Physical Therapist
  • San Luis Obispo, CA
National Provider Identifier
1104641877
Registry record updated Nov 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT41949 Issued in FL
Practice address
253 Granada Dr Ste D
San Luis Obispo, CA 93401-7340
Phone
(805) 543-2244
NPI assigned
Nov 18, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT41949 FL Primary
Physical Therapist 225100000X P23554 NC

Addresses

Primary practice location

253 Granada Dr Ste D
San Luis Obispo, CA 93401-7340

Mailing address

4000 SW 2ND Ave
Cape Coral, FL 33914-7866
Phone (913) 894-6106

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PT41949FLMDPhysical Therapist
P23554NCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Central Coast Home Health, Inc. PastSince Nov 24, 2024 Accepting new patients
Central Coast Home Health Inc PastSince Nov 24, 2024 Accepting new patients

Organizations & group practices 2

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": "1731888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731888000000",
    "number": "1104641877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 SW 2ND AVE",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339147866",
            "telephone_number": "913-894-6106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "253 GRANADA DR STE D",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934017340",
            "telephone_number": "805-543-2244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "YANKOVICH",
        "first_name": "JARED",
        "middle_name": "FRANCIS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-11-18",
        "last_updated": "2024-11-18",
        "certification_date": "2024-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT41949",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P23554",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis Obispo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.