Jason R Vandeventer, MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

05007082A Issued in IN

Practice address

719 S Rogers St
Bloomington, IN 47403-2335

Phone

(812) 323-4475

Fax

(812) 323-4478

NPI assigned

Jun 16, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Ima, Inc. Physical Therapy

  • Physical Therapy Clinic/Center
  • Bloomington, IN
  • NPI 1750564274
  NPD (past)
• Theraplay LLC

  • Physical Therapist
  • Bloomington, IN
  • NPI 1598708109
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222387200000",
    "number": "1205831070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 S LANDMARK AVE",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474033239",
            "telephone_number": "812-323-4475",
            "fax_number": "812-323-4478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 S ROGERS ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474032335",
            "telephone_number": "812-323-4475",
            "fax_number": "812-323-4478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDEVENTER",
        "first_name": "JASON",
        "middle_name": "R",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2008-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05007082A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200363990",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Karen Vanarsdale, LCSW
• Paul Joseph Vandekoppel, MD
• Madeleine Jane Vandenbrink, MD
• Larry Wayne Vandermolen, PA-C
• David Vandeventer, BCBA
• Vickie L Vandeventer, FNP
• Grace Vandiver
• Sandra Ellen Vangilder
• Amara Vanmatre, RBT
• Veneda K Vann, N.P.

• Physical Therapist in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2008; 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.