Individual provider Active NPI

Jessica Johnson

  • Physical Therapist
  • Bridgeton, MO
National Provider Identifier
1205380722
Registry record updated Jan 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2016026835 Issued in MO
Practice address
12468 Saint Charles Rock Rd
Bridgeton, MO 63044-2506
Phone
(314) 739-1123
Fax
(314) 739-1173
NPI assigned
Aug 12, 2016
Last updated
Jan 2, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 2, 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 2016026835 MO Primary

Addresses

Primary practice location

12468 Saint Charles Rock Rd
Bridgeton, MO 63044-2506

Mailing address

600 Oakmont LN
Ste 600C
Westmont, IL 60559-5548
Phone (630) 575-1980

Other names 1

  • Jessica Meyer Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160819001872 MO Practitioner - Physical Therapist in Private Practice 8325333065 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Athletico LTDGroup PAC ID 4789602681, 2,187 clinicians

Practice addresses (Care Compare)

1832 Wentzville Pkwy
Wentzville, MO 63385-3817
Phone (636) 327-7110

Merit-based Incentive Payment System (MIPS)

Final score
86.32 of 100Reported as group
Quality
84.44
Promoting interoperability
99
Improvement activities
40
Cost
70.78

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2016026835MOMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Athletico LTD Physical Therapist CurrentSince Jun 24, 2020 Accepting new patients
Athletico LTD Physical Therapist Current Accepting new patients
Athletico LTD Physical Therapist CurrentSince Jun 24, 2020 Accepting new patients

Locations

625 Enterprise Dr
Oak Brook, IL 60523
Phone (630) 575-6250

600 Oakmont Ln
Ste 600C
Westmont, IL 60559
Phone (630) 575-6250

12468 Saint Charles Rock Rd
Bridgeton, MO 63044
Phone (314) 739-1123

229 S Stewart Rd
Ste E3
Liberty, MO 64068
Phone (816) 656-3695

951 Waterbury Falls Dr
O Fallon, MO 63368
Phone (636) 336-0300

2007 W Foxwood Dr
Ste D
Raymore, MO 64083
Phone (816) 265-8116

107 Concord Plaza Shopping Ctr
Saint Louis, MO 63128
Phone (314) 842-2990

1832 Wentzville Pkwy
Wentzville, MO 63385
Phone (636) 327-7110

Interoperability endpoints

  • Direct secure messaging: jessica.meyer.p2@direct.athleticoltd.nextgenshare.com

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": "1470960000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735776000000",
    "number": "1205380722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 OAKMONT LN",
            "address_2": "STE 600C",
            "city": "WESTMONT",
            "state": "IL",
            "postal_code": "605595548",
            "telephone_number": "630-575-1980",
            "fax_number": "630-928-5080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12468 SAINT CHARLES ROCK RD",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442506",
            "telephone_number": "314-739-1123",
            "fax_number": "314-739-1173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JESSICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-12",
        "last_updated": "2025-01-02",
        "certification_date": "2025-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2016026835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "MEYER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bridgeton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 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.