Individual provider Active NPI

Chris M. Ota, RPT

  • Sports Physical Therapist
  • Campbell, CA
National Provider Identifier
1275613119
Registry record updated Oct 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physical TherapistTaxonomy code 2251S0007X
License
PT13225 Issued in CA
Practice address
163 E Hamilton Ave
Campbell, CA 95008-0234
Phone
(408) 866-5567
Fax
(408) 866-1317
NPI assigned
Oct 16, 2006
Last updated
Oct 18, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physical Therapist 2251S0007X PT13225 CA Primary

Addresses

Primary practice location

163 E Hamilton Ave
Campbell, CA 95008-0234

Mailing address

163 E Hamilton Ave
Campbell, CA 95008-0234
Phone (408) 866-5567

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address derry@campbellpt.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120709000598 CA Practitioner - Physical Therapist in Private Practice 9537326384 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Campbells Premier Physical Therapy IncGroup PAC ID 9739570078, 4 clinicians

Practice addresses (Care Compare)

163 E Hamilton Ave
Campbell, CA 95008-0245
Phone (408) 866-5567

Merit-based Incentive Payment System (MIPS)

Final score
94.27 of 100Reported as individual
Quality
92.14
Improvement activities
40
Cost
88.95

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
CS Physical Therapy Corporation Sports CurrentSince Oct 1, 2021 Accepting new patients
Campbell's Premier Physical Therapy, Inc Sports CurrentSince Sep 29, 2021 Accepting new patients
Diane Shiraishi & Chris Ota PTRS Sports Current Accepting new patients

Locations

163 E Hamilton Ave
Campbell, CA 95008
Phone (408) 866-5567

2337 Forest Ave
San Jose, CA 95128
Phone (408) 246-5861

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

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": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634515200000",
    "number": "1275613119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "163 E HAMILTON AVE",
            "city": "CAMPBELL",
            "state": "CA",
            "postal_code": "950080234",
            "telephone_number": "408-866-5567",
            "fax_number": "408-866-1317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "163 E HAMILTON AVE",
            "city": "CAMPBELL",
            "state": "CA",
            "postal_code": "950080234",
            "telephone_number": "408-866-5567",
            "fax_number": "408-866-1317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTA",
        "first_name": "CHRIS",
        "middle_name": "M.",
        "name_prefix": "Mr.",
        "credential": "RPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2021-10-18",
        "certification_date": "2021-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "CA",
            "license": "PT13225",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "derry@campbellpt.com",
            "affiliation": "N",
            "endpointDescription": "Office manager/Administer",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "163 E Hamilton Ave",
            "city": "Campbell",
            "state": "CA",
            "country_code": "US",
            "postal_code": "950080234",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Campbell, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2021; 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.