Individual provider Active NPI

Jason Antone Santos, M.P.T.

  • Physical Therapist
  • San Anselmo, CA
National Provider Identifier
1154456804
Registry record updated Jan 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT. 32713 Issued in CA
Practice address
220 Greenfield Ave
San Anselmo, CA 94960-2416
Phone
(415) 457-4454
Fax
(415) 457-4944
NPI assigned
Feb 22, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2011

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 PT. 32713 CA Primary

Addresses

Primary practice location

220 Greenfield Ave
San Anselmo, CA 94960-2416

Mailing address

220 Greenfield Ave
San Anselmo, CA 94960-2416
Phone (415) 457-4454

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT. 32713CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Sport & Spine Therapy of Marin Inc Physical Therapist Past Accepting new patients
Sport & Spine Therapy of Marin Inc Physical Therapist Past Accepting new patients
Presidio Sport & Medicine, Inc. Physical Therapist PastSince May 4, 2002 Accepting new patients

Organizations & group practices 3

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": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295395200000",
    "number": "1154456804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 GREENFIELD AVE",
            "city": "SAN ANSELMO",
            "state": "CA",
            "postal_code": "949602416",
            "telephone_number": "415-457-4454",
            "fax_number": "415-457-4944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 GREENFIELD AVE",
            "city": "SAN ANSELMO",
            "state": "CA",
            "postal_code": "949602416",
            "telephone_number": "415-457-4454",
            "fax_number": "415-457-4944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANTOS",
        "first_name": "JASON",
        "middle_name": "ANTONE",
        "credential": "M.P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-22",
        "last_updated": "2011-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT. 32713",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Anselmo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.