Individual provider Active NPI

Jareb C Landon, PT, DPT

  • Physical Therapist
  • Daytona Beach, FL
National Provider Identifier
1295293652
Registry record updated Nov 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT-34078 Issued in FL
Practice address
1865 Lpga Blvd
Daytona Beach, FL 32117-7108
Phone
(386) 255-4596
Fax
(386) 257-0558
NPI assigned
Mar 5, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X PT-34078 FL
Physical Therapist 225100000X PT-34078 FL Primary
Pediatric Physical Therapist 2251P0200X PT6215 ID

Addresses

Primary practice location

1865 Lpga Blvd
Daytona Beach, FL 32117-7108

Mailing address

1865 Lpga Blvd
Daytona Beach, FL 32117-7108
Phone (386) 255-4596

Other practice location 1

1075 Mason Ave
Daytona Beach, FL 32117-4690
Phone (386) 255-4596

Other identifiers 1

IdentifierTypeStateIssuer
111170900MedicaidFL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210715000128 FL Practitioner - Physical Therapist in Private Practice 4385046275 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

17 Old Kings Rd N
Suite K
Palm Coast, FL 32137-8283
Phone (386) 255-4596

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as individual

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT6215IDMDPediatric Physical Therapist
PT-34078FLMDOrthopedic Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopaedic Clinic of Daytona Beach PA CurrentSince Aug 1, 2021 Accepting new patients
Orthopaedic Clinic of Daytona Beach PA CurrentSince Aug 1, 2021 Accepting new patients
Mountain View Hospital LLC Past Accepting new patients
Speech and Language Clinic, Inc Past Accepting new patients

Locations

1865 Lpga Blvd
Daytona Beach, FL 32117
Phone (386) 255-4596

1075 Mason Ave
Daytona Beach, FL 32117
Phone (386) 255-4596

1890 Lpga Blvd
Ste 240
Daytona Beach, FL 32117
Phone (386) 255-4596

17 Old Kings Rd N
Ste K
Palm Coast, FL 32137
Phone (386) 255-4596

1165 Dunlawton Ave
Ste 102
Port Orange, FL 32127
Phone (386) 255-4596

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/10735/brand/1/csg/1/fhir/r4
  • Direct secure messaging: jareb.landon.1@10735.direct.athenahealth.com

Organizations & group practices 4

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": "1551744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732060800000",
    "number": "1295293652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1865 LPGA BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321177108",
            "telephone_number": "386-255-4596",
            "fax_number": "386-257-0558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1865 LPGA BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321177108",
            "telephone_number": "386-255-4596",
            "fax_number": "386-257-0558"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1075 Mason Ave",
            "address_purpose": "LOCATION",
            "city": "Daytona Beach",
            "state": "FL",
            "postal_code": "321174690",
            "country_code": "US",
            "telephone_number": "386-255-4596",
            "fax_number": "386-257-0558",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LANDON",
        "first_name": "JAREB",
        "middle_name": "C",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-05",
        "last_updated": "2024-11-20",
        "certification_date": "2024-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "FL",
            "license": "PT-34078",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT-34078",
            "primary": true
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "ID",
            "license": "PT6215",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "111170900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Daytona Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2024; 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.