Individual provider Active NPI

Jamie Marie Deerr, DPT

  • Physical Therapist
  • Greenwood, IN
National Provider Identifier
1144889486
Registry record updated Mar 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
05013352A Issued in IN
Practice address
3000 S State Road 135
Greenwood, IN 46143-9825
Phone
(317) 535-4075
NPI assigned
Jun 11, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2022

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 05013352A IN Primary

Addresses

Primary practice location

3000 S State Road 135
Greenwood, IN 46143-9825

Mailing address

4032 Woodstone Dr
Floyds Knobs, IN 47119-9718
Phone (502) 762-3849

Other names 1

  • Jamie Marie Wallace Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190726002419 IN Practitioner - Physical Therapist in Private Practice 5698001782 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
CHN JMH Ventures LLCGroup PAC ID 3870728512, 20 clinicians

Practice addresses (Care Compare)

3000 S State Rd
135 Suite 110
Greenwood, IN 46143-9829
Phone (317) 497-6000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
05013352AINMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
CHN JMH Ventures LLC CurrentSince Jul 1, 2019 Accepting new patients
CHN JMH Ventures LLC Physical Therapist CurrentSince Jul 1, 2019 Accepting new patients

Locations

7598 Solutions Ctr
Chicago, IL 60677

3000 S State Road 135
Greenwood, IN 46143
Phone (317) 497-6000

3000 S State Road 135
Ste 110
Greenwood, IN 46143
Phone (317) 497-6000

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": "1560211200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646784000000",
    "number": "1144889486",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4032 WOODSTONE DR",
            "city": "FLOYDS KNOBS",
            "state": "IN",
            "postal_code": "471199718",
            "telephone_number": "502-762-3849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 S STATE ROAD 135",
            "city": "GREENWOOD",
            "state": "IN",
            "postal_code": "461439825",
            "telephone_number": "317-535-4075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEERR",
        "first_name": "JAMIE",
        "middle_name": "MARIE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-11",
        "last_updated": "2022-03-09",
        "certification_date": "2022-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05013352A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAMIE",
            "last_name": "WALLACE",
            "middle_name": "MARIE",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Greenwood, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2022; 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.