Individual provider Active NPI

Jeffrey Brandon Jenson, DPT

  • Physical Therapist
  • Fairmont, WV
National Provider Identifier
1285170472
Registry record updated Aug 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
004643 Issued in WV
Practice address
51 Middletown Rd
Fairmont, WV 26554-8176
Phone
(304) 534-8122
Fax
(304) 534-8131
NPI assigned
Jan 11, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X
Community Health Worker 172V00000X
Physical Therapist 225100000X 004643 WV Primary

Addresses

Primary practice location

51 Middletown Rd
Fairmont, WV 26554-8176

Mailing address

610 Windwood PL
Morgantown, WV 26505-2771
Phone (435) 899-0405

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231011001239 WV Practitioner - Physical Therapist in Private Practice 8729433701 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
West Virginia University School of Medicine, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Elevate Physical Therapy CorpGroup PAC ID 6800263955, 9 clinicians

Practice addresses (Care Compare)

51 Middletown Rd
Suite 102
Fairmont, WV 26554-8177
Phone (304) 534-8122

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
004643WVMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Elevate Physical Therapy, Corp. Physical Therapist CurrentSince Aug 1, 2023 Accepting new patients
Fairmont Home Equipment & Supply Company PastSince Aug 1, 2023 Accepting new patients

Locations

51 Middletown Rd
Ste 102
White Hall, WV 26554
Phone (304) 367-8130

51 Middletown Rd
White Hall, WV 26554
Phone (304) 534-8122

Organizations & group practices 2

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": "1484092800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691971200000",
    "number": "1285170472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 WINDWOOD PL",
            "city": "MORGANTOWN",
            "state": "WV",
            "postal_code": "265052771",
            "telephone_number": "435-899-0405",
            "fax_number": "304-534-8131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "51 MIDDLETOWN RD",
            "city": "FAIRMONT",
            "state": "WV",
            "postal_code": "265548176",
            "telephone_number": "304-534-8122",
            "fax_number": "304-534-8131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENSON",
        "first_name": "JEFFREY",
        "middle_name": "BRANDON",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-11",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WV",
            "license": "004643",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairmont, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; 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.