Individual provider Active NPI

Jessica Hollis, MPT

  • Physical Therapist
  • Laguna Niguel, CA
National Provider Identifier
1205295433
Registry record updated Feb 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
26742 Issued in CA
Practice address
19 High BLF
Laguna Niguel, CA 92677-4259
Phone
(949) 466-9506
NPI assigned
Feb 16, 2016
Last updated
Feb 16, 2016By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 16, 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 26742 CA Primary

Addresses

Primary practice location

19 High BLF
Laguna Niguel, CA 92677-4259

Mailing address

19 High BLF
Laguna Niguel, CA 92677-4259
Phone (949) 466-9506

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160317000542 CA Practitioner - Physical Therapist in Private Practice 0648576603 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New Life Physical Therapy Services PCGroup PAC ID 7214207125, 94 clinicians

Practice addresses (Care Compare)

27762 Forbes Rd
Laguna Niguel, CA 92677-1203
Phone (749) 676-0197

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
New Life Physical Therapy Services, PC Physical Therapist CurrentSince Aug 4, 2024 Accepting new patients
California Luna Care Physical Therapy PC Physical Therapist CurrentSince Jun 2, 2022 Accepting new patients
New Life Healthcare, LLC Past Accepting new patients
JM Physical Therapy Inc Physical Therapist Past Accepting new patients
Trellis Physical Therapy a Professional Rehab Group Inc. Physical Therapist Past Accepting new patients

Locations

17122 Beach Blvd
Ste 101
Huntington Beach, CA 92647
Phone (714) 848-7191

5321 La Palma Ave
La Palma, CA 90623

27762 Forbes Rd
Laguna Niguel, CA 92677
Phone (749) 676-0197

16185 Los Gatos Blvd
Ste 205
Los Gatos, CA 95032
Phone (408) 409-4167

26151 Country Club Dr
Mission Viejo, CA 92691
Phone (949) 203-0009

12515 Springhurst Dr
San Diego, CA 92128
Phone (858) 771-3694

12291 Newport Ave
Santa Ana, CA 92705
Phone (714) 544-5959

Organizations & group practices 5

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": "1455580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455580800000",
    "number": "1205295433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19 HIGH BLF",
            "city": "LAGUNA NIGUEL",
            "state": "CA",
            "postal_code": "926774259",
            "telephone_number": "949-466-9506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19 HIGH BLF",
            "city": "LAGUNA NIGUEL",
            "state": "CA",
            "postal_code": "926774259",
            "telephone_number": "949-466-9506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLLIS",
        "first_name": "JESSICA",
        "name_prefix": "Mrs.",
        "credential": "MPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-02-16",
        "last_updated": "2016-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "26742",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Laguna Niguel, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 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.