Individual provider Active NPI

John C Kawas, PT

  • Physical Therapist
  • Port Jefferson, NY
National Provider Identifier
1104930908
Registry record updated May 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
020893-1 Issued in NY
Practice address
655 Belle Terre Rd
Apart 55
Port Jefferson, NY 11777-1960
Phone
(631) 974-0026
NPI assigned
Aug 18, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 21, 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 020893-1 NY Primary

Addresses

Primary practice location

655 Belle Terre Rd
Apart 55
Port Jefferson, NY 11777-1960

Mailing address

655 Belle Terre Rd
Apart 55
Port Jefferson, NY 11777-1960
Phone (631) 974-0026

Other identifiers 1

IdentifierTypeStateIssuer
6697169OtherNYGHI

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, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

Holbrook, NY 11741
Phone (631) 866-6507

1548 Carl Ave
Holbrook, NY 11741-2318

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
020893NYMDPsychologist
020893-1NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Family Residences and Essential Enterprises, Inc. Past Accepting new patients
Michele Rauer Physical Therapy Assistant, P.C. Physical Therapist PastSince Nov 28, 2021 Accepting new patients
CRS Homebased Physical Therapy, P.C. Physical Therapist PastSince Jun 5, 2004 Accepting new patients
Sherrie Glasser Physical Therapy/John Douglas Pta Past Accepting new patients

Organizations & group practices 5

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": "1155859200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369094400000",
    "number": "1104930908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 BELLE TERRE RD",
            "address_2": "APART 55",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771960",
            "telephone_number": "631-974-0026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 BELLE TERRE RD",
            "address_2": "APART 55",
            "city": "PORT JEFFERSON",
            "state": "NY",
            "postal_code": "117771960",
            "telephone_number": "631-974-0026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAWAS",
        "first_name": "JOHN",
        "middle_name": "C",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-18",
        "last_updated": "2013-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "020893-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GHI",
            "identifier": "6697169",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Jefferson, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2013; 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.

Verify at the official NPI Registry.