Active NPI
Jonathan Ponce Susas, PT
- Physical Therapist
- Sacramento, CA
National Provider Identifier
1154400158
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 33498
- Practice address
- 2315 Stockton Blvd
UC Davis Medical Center - PM&R
Sacramento, CA 95817-2201 - Phone
- (916) 734-2011
- NPI assigned
- Nov 2, 2006
- Reactivated
- Jan 26, 2024
- Last updated
- Jan 26, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 22631 | FL | |
| Physical Therapist | 225100000X | 9025 | CO | |
| Physical Therapist | 225100000X | 33498 | CA | Primary |
Addresses
Primary practice location
2315 Stockton Blvd
UC Davis Medical Center - PM&R
Sacramento, CA 95817-2201
Mailing address
2315 Stockton Blvd
UC Davis Medical Center - PM&R
Sacramento, CA 95817
Phone (916) 734-2011
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9025 | CO | MD | Physical Therapist |
| 22631 | FL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Abbacare at Home Corp | Current | Accepting new patients | |
| Clinicians Connect Care Home Health & Hospice Services | Current | 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.
-
dba Clinicians Connect Care Home Health
- Home Health Agency
- West Sacramento, CA
- NPI 1174000855
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162425600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706227200000",
"number": "1154400158",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2315 STOCKTON BLVD",
"address_2": "UC DAVIS MEDICAL CENTER - PM&R",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "95817",
"telephone_number": "916-734-2011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2315 STOCKTON BLVD",
"address_2": "UC DAVIS MEDICAL CENTER - PM&R",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958172201",
"telephone_number": "916-734-2011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUSAS",
"first_name": "JONATHAN",
"middle_name": "PONCE",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-02",
"last_updated": "2024-01-26",
"certification_date": "2022-07-26",
"deactivation_date": "2022-07-26",
"reactivation_date": "2024-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "22631",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CO",
"license": "9025",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "33498",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.