Jacob Wilson

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT60960737 Issued in WA

Practice address

2000 S Main St
Fairfield, IA 52556-9572

Phone

(641) 472-4111

NPI assigned

Jan 18, 2018

Last updated

Jul 3, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advance Physical Therapy and Sports Medicine of Chatham LLCGroup PAC ID 8426124561, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Advance Physical Therapy & Sports Medicine of Chatham LLC

  • Physical Therapist
  • Chatham, IL
  • NPI 1376706234
  Medicare reassignment Care Compare group NPD
• Advance Physical Therapy & Sports Medicine of Chatham LLC

  dba Advance Physical Therapy

  • Physical Therapy Clinic/Center
  • Mt Sterling, IL
  • NPI 1619554797
  NPD

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

{
    "created_epoch": "1516233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562112000000",
    "number": "1255849626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1020 945E ST",
            "city": "MOUNT STERLING",
            "state": "IL",
            "postal_code": "623534410",
            "telephone_number": "217-257-0369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 S MAIN ST",
            "city": "FAIRFIELD",
            "state": "IA",
            "postal_code": "525569572",
            "telephone_number": "641-472-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "JACOB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-01-18",
        "last_updated": "2019-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60960737",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IA",
            "license": "090148",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Weinand, PHD
• Kayla Weirup, RPH
• Christian Andrew Wells, PTA
• Wellspring Chiropractic Clinic PLLC
• Donna Jean Williams, PT, CWS
• Heidi Suzanne Winn, LMHC
• Emily Wofford, LMSW
• Wolfe Clinic Eye Centers, LC
• Patricia Worsham, MOT
• Worthy Within

• Physical Therapist in Fairfield, IA
• Providers in Fairfield, IA by specialty
• Physical Therapist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2019; 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.