NPIMap

Organization Active NPI

Shasta Lake Physical Therapy

  • Physical Therapist
  • Shasta Lake, CA
National Provider Identifier
1255376893
Registry record updated Feb 25, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
00-0004 Issued in CA
Legal business name
SHASTA LAKE PHYSICAL THERAPY
Practice address
5061 Shasta Dam Blvd
Shasta Lake, CA 96019-9422
Phone
(530) 275-0777
Fax
(530) 275-8779
NPI assigned
Jun 18, 2006
Last updated
Feb 25, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2009

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

Authorized official

Name
Mr. Donald Roy Baas, P.T.NPI 1245268317
Title
Co-Owner / Physical Therapist
Phone
(530) 221-9952

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 00-0004 CA Primary

Addresses

Primary practice location

5061 Shasta Dam Blvd
Shasta Lake, CA 96019-9422

Mailing address

PO Box 493396
Redding, CA 96049-3396
Phone (530) 221-9952

Other identifiers 1

IdentifierTypeStateIssuer
GPT1000840MedicaidCA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050607000966 CA Part B Supplier - Physical/Occupational Therapy Group in Private Practice 1557304896 Receives reassigned benefits from 13 practitioners
Practice locations: Shasta Lake, CA

National Provider Directory

National Provider Directory

Locations

4216 Shasta Dam Blvd
Shasta Lake, CA 96019
Phone (530) 275-0777

5061 Shasta Dam Blvd
Shasta Lake, CA 96019
Phone (530) 275-0777

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235520000000",
    "number": "1255376893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 493396",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960493396",
            "telephone_number": "530-221-9952",
            "fax_number": "530-221-9554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5061 SHASTA DAM BLVD",
            "city": "SHASTA LAKE",
            "state": "CA",
            "postal_code": "960199422",
            "telephone_number": "530-275-0777",
            "fax_number": "530-275-8779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHASTA LAKE PHYSICAL THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-18",
        "last_updated": "2009-02-25",
        "status": "A",
        "authorized_official_last_name": "BAAS",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "ROY",
        "authorized_official_title_or_position": "CO-OWNER / PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "530-221-9952",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "00-0004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GPT1000840",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shasta Lake, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.