Individual provider Active NPI

Jason Smutnick, MS, PT

  • Physical Therapist
  • Watertown, CT
National Provider Identifier
1114171923
Registry record updated Nov 6, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
008437 Issued in CT
Practice address
27 Depot St
Watertown, CT 06795-2601
Phone
(860) 274-1487
Fax
(860) 274-4860
NPI assigned
Nov 6, 2008
Last updated
Nov 6, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2008

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 008437 CT Primary

Addresses

Primary practice location

27 Depot St
Watertown, CT 06795-2601

Mailing address

270 Farmington Ave
Suite 303
Farmington, CT 06032-1909
Phone (860) 409-4595

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081215000418 CT Practitioner - Physical Therapist in Private Practice 0840352589 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anb-Ptsma Holdings IncGroup PAC ID 4789572926, 190 clinicians

Practice addresses (Care Compare)

645 Poquonock Ave
Suite a
Windsor, CT 06095-2226
Phone (860) 752-6900

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
008437CTMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Norwich Orthopedic Group, P.C. Physical Therapist Past 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1225929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1225929600000",
    "number": "1114171923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "270 FARMINGTON AVE",
            "address_2": "SUITE 303",
            "city": "FARMINGTON",
            "state": "CT",
            "postal_code": "060321909",
            "telephone_number": "860-409-4595",
            "fax_number": "860-409-4860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27 DEPOT ST",
            "city": "WATERTOWN",
            "state": "CT",
            "postal_code": "067952601",
            "telephone_number": "860-274-1487",
            "fax_number": "860-274-4860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMUTNICK",
        "first_name": "JASON",
        "credential": "MS, PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-06",
        "last_updated": "2008-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "008437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2008; 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.