Individual provider Active NPI

Braden Gage Jackson

  • Physical Therapist
  • Lexington, KY
National Provider Identifier
1124830419
Registry record updated Feb 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
009273 Issued in KY
Practice address
1010 Monarch St Ste 150
Lexington, KY 40513-1892
Phone
(859) 219-0211
NPI assigned
Jan 23, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2025

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 009273 KY Primary

Addresses

Primary practice location

1010 Monarch St Ste 150
Lexington, KY 40513-1892

Mailing address

1200 Corporate Dr Ste 400
Hoover, AL 35242-5424
Phone (423) 238-7217

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250217002610 KY Practitioner - Physical Therapist in Private Practice 8729508031 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Agilitas USA, IncGroup PAC ID 3375454648, 812 clinicians
Benchmark Physical Therapy of Ky LLCGroup PAC ID 0042577579, 55 clinicians

Practice addresses (Care Compare)

150 W Lowry LN
Suite 150
Lexington, KY 40503-3030
Phone (859) 421-4416

1588 Leestown Rd
Suite 120
Lexington, KY 40511-2365
Phone (859) 317-8086

2160 Sir Barton Way
Suite 146
Lexington, KY 40509-2229
Phone (859) 300-0440

7800 John Davis Dr
Suite 460
Frankfort, KY 40601-6577
Phone (502) 699-2734

805 Blankenbaker Pkwy
Suite 107
Louisville, KY 40243-2804
Phone (502) 253-0833

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Agilitas USA, Inc Physical Therapist CurrentSince Feb 5, 2025 Accepting new patients
Benchmark Physical Therapy of Ky LLC Physical Therapist CurrentSince Feb 5, 2025 Accepting new patients
Agilitas USA Inc Physical Therapist CurrentSince Feb 5, 2025 Accepting new patients
Results-Ast JV, LLC Physical Therapist CurrentSince Feb 5, 2025 Accepting new patients
Drayer Physical Therapy Kentucky LLC Physical Therapist CurrentSince Feb 5, 2025 Accepting new patients
Drayer Physical Therapy Kentucky LLC Physical Therapist CurrentSince Feb 5, 2025 Accepting new patients
Agilitas USA Inc Past Accepting new patients

Locations

1200 Corporate Dr
Ste 400
Hoover, AL 35242
Phone (423) 238-7568

1725 Scottsville Rd
Bowling Green, KY 42104
Phone (270) 467-9969

2160 Sir Barton Way
Ste 146
Lexington, KY 40509
Phone (859) 300-0440

1588 Leestown Rd
Ste 120
Lexington, KY 40511
Phone (859) 317-8086

1010 Monarch St
Ste 150
Lexington, KY 40513
Phone (859) 219-0211

805 Blankenbaker Pkwy
Louisville, KY 40243
Phone (502) 253-0833

602 Keene Centre Dr
Nicholasville, KY 40356
Phone (859) 544-1762

200 Codella Dr
Ste B
Winchester, KY 40391
Phone (859) 745-2152

Organizations & group practices 8

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": "1737590400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738713600000",
    "number": "1124830419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 CORPORATE DR STE 400",
            "city": "HOOVER",
            "state": "AL",
            "postal_code": "352425424",
            "telephone_number": "423-238-7217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 MONARCH ST STE 150",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405131892",
            "telephone_number": "859-219-0211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "BRADEN",
        "middle_name": "GAGE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-01-23",
        "last_updated": "2025-02-05",
        "certification_date": "2025-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KY",
            "license": "009273",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2025; 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.