Individual provider Active NPI

Jessica Johnson, PT

  • Physical Therapist
  • Madison, WI
National Provider Identifier
1275640914
Registry record updated Mar 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
10400-024 Issued in WI
Practice address
4602 Eastpark Blvd
Madison, WI 53718-2002
Phone
(608) 440-6440
NPI assigned
Aug 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 10400-024 WI Primary

Addresses

Primary practice location

4602 Eastpark Blvd
Madison, WI 53718-2002

Mailing address

557 N Washington St
Janesville, WI 53548-2907
Phone (608) 754-6000

Other practice location 1

557 N Washington St
Janesville, WI 53548-2907
Phone (608) 754-6000

Other identifiers 1

IdentifierTypeStateIssuer
40454800MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10400-024WIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Chad Novasic PT LTD Physical Therapist Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616457600000",
    "number": "1275640914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "557 N WASHINGTON ST",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535482907",
            "telephone_number": "608-754-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4602 EASTPARK BLVD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537182002",
            "telephone_number": "608-440-6440"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "557 N Washington St",
            "address_purpose": "LOCATION",
            "city": "Janesville",
            "state": "WI",
            "postal_code": "535482907",
            "country_code": "US",
            "telephone_number": "608-754-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JESSICA",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-25",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "10400-024",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40454800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2021; 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.