NPIMap

Organization Active NPI

Premier Physical Therapy Sport Medicine Inc

  • Physical Therapist
  • Fort Pierce, FL
National Provider Identifier
1265542682
Registry record updated Feb 19, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
PREMIER PHYSICAL THERAPY SPORT MEDICINE INC
Practice address
800 Virginia Ave Ste 48
Fort Pierce, FL 34982-5893
Phone
(772) 464-6424
Fax
(772) 464-4324
NPI assigned
Aug 30, 2006
Last updated
Feb 19, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2020

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

Authorized official

Name
Jeffrey Alan Tucker, MPTNPI 1982725230
Title
Executive Director
Phone
(772) 335-7966

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 NU Primary

Addresses

Primary practice location

800 Virginia Ave Ste 48
Fort Pierce, FL 34982-5893

Mailing address

PO Box 8600
Port St Lucie, FL 34985
Phone (772) 335-7966

Other identifiers 3

IdentifierTypeStateIssuer
CK5189OtherFLRAILROAD MEDICARE PTAN
650023083OtherFLRAILROAD MEDICARE
Y904GOtherFLBCBS PROVIDER NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040318000876 FL Part B Supplier - Clinic/Group Practice 3173413549 Receives reassigned benefits from 59 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Palm City, FL; West Palm Beach, FL; Vero Beach, FL; Stuart, FL; Port St Lucie, FL; Melbourne, FL; Jensen Beach, FL; Fort Pierce, FL…

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Premier Physical Therapy Sports Medicine8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2217 S 25th St
Fort Pierce, FL 34947
Phone (772) 464-6424

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582070400000",
    "number": "1265542682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8600",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "34985",
            "telephone_number": "772-335-7966",
            "fax_number": "772-335-7963"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 VIRGINIA AVE STE 48",
            "city": "FORT PIERCE",
            "state": "FL",
            "postal_code": "349825893",
            "telephone_number": "772-464-6424",
            "fax_number": "772-464-4324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER PHYSICAL THERAPY SPORT MEDICINE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-02-19",
        "certification_date": "2020-02-19",
        "status": "A",
        "authorized_official_last_name": "TUCKER",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "772-335-7966",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PTAN",
            "identifier": "CK5189",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "650023083",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "Y904G",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Pierce, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2020; 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.