Individual provider Active NPI

Jason John Putz, P.T.

  • Physical Therapist
  • Dyersville, IA
National Provider Identifier
1114972775
Registry record updated Nov 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
03051 Issued in IA
Practice address
1129 11TH St SE
Suite a
Dyersville, IA 52040
Phone
(563) 875-8615
Fax
(563) 875-8722
NPI assigned
May 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2016

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 03051 IA Primary

Addresses

Primary practice location

1129 11TH St SE
Suite a
Dyersville, IA 52040

Mailing address

1129 11TH St SE
Suite a
Dyersville, IA 52040
Phone (563) 875-8615

Other identifiers 2

IdentifierTypeStateIssuer
1209163MedicaidIA
35223OtherIABLUE SHIELD PROVIDER #

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070925000665 IA Practitioner - Physical Therapist in Private Practice 3577657212 Reassigns benefits to 1 organization

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
Jason J. Putz Physical Therapy P.C.Group PAC ID 2769578657, 18 clinicians

Practice addresses (Care Compare)

1129 11TH St SE a
Dyersville, IA 52040-2418
Phone (563) 875-8615

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
03051IAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Jason J. Putz Physical Therapy P.C. CurrentSince Oct 24, 2007 Accepting new patients
Physical Therapy Services PC Physical Therapist PastSince Jul 1, 2012 Accepting new patients
Physical Therapy Services PC Physical Therapist Past Accepting new patients
Jet PT PC Physical Therapist Past Accepting new patients

Locations

245 Railroad Ave
Ste F2
Dubuque, IA 52003
Phone (563) 231-9900

1129 11th St SE
Ste A
Dyersville, IA 52040
Phone (563) 875-8615

107 S 11th St
Ste 1
Manchester, IA 52057
Phone (563) 927-1499

Organizations & group practices 4

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": "1148342400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478649600000",
    "number": "1114972775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1129 11TH ST SE",
            "address_2": "SUITE A",
            "city": "DYERSVILLE",
            "state": "IA",
            "postal_code": "52040",
            "telephone_number": "563-875-8615",
            "fax_number": "563-875-8722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1129 11TH ST SE",
            "address_2": "SUITE A",
            "city": "DYERSVILLE",
            "state": "IA",
            "postal_code": "52040",
            "telephone_number": "563-875-8615",
            "fax_number": "563-875-8722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUTZ",
        "first_name": "JASON",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-23",
        "last_updated": "2016-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IA",
            "license": "03051",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1209163",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER #",
            "identifier": "35223",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dyersville, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2016; 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.