Active NPI
Jason Koster, PT
- Physical Medicine & Rehabilitation Physician
- Mount Shasta, CA
National Provider Identifier
1295063832
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 27887
- Practice address
- 633 Lassen LN
Mount Shasta, CA 96067-9002 - Phone
- (530) 926-6010
- Fax
- (530) 926-6909
- NPI assigned
- Nov 19, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 27887 | CA | Primary |
Addresses
Primary practice location
633 Lassen LN
Mount Shasta, CA 96067-9002
Mailing address
633 Lassen LN
Mount Shasta, CA 96067-9002
Phone (530) 926-6010
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
| License | State | Type | Specialty |
|---|---|---|---|
| 27887 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1258588800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1258588800000",
"number": "1295063832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "633 LASSEN LN",
"city": "MOUNT SHASTA",
"state": "CA",
"postal_code": "960679002",
"telephone_number": "530-926-6010",
"fax_number": "530-926-6909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "633 LASSEN LN",
"city": "MOUNT SHASTA",
"state": "CA",
"postal_code": "960679002",
"telephone_number": "530-926-6010",
"fax_number": "530-926-6909"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOSTER",
"first_name": "JASON",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-11-19",
"last_updated": "2009-11-19",
"status": "A"
},
"taxonomies": [
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "CA",
"license": "27887",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Shasta, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.