Individual provider Active NPI

Jeremy Velasco, PT, DPT

  • Physical Therapist
  • La Mesa, CA
National Provider Identifier
1306412283
Registry record updated Jun 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
300196 Issued in CA
Practice address
8491 Fletcher Pkwy
La Mesa, CA 91942-3005
Phone
(619) 460-0137
NPI assigned
Jun 1, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 1, 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 300196 CA Primary

Addresses

Primary practice location

8491 Fletcher Pkwy
La Mesa, CA 91942-3005

Mailing address

3959 Ruffin Rd Ste J
San Diego, CA 92123-1830
Phone (858) 279-5570

Other practice location 1

3959 Ruffin Rd Ste J
San Diego, CA 92123-1830
Phone (858) 279-5570

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210610000466 CA Practitioner - Physical Therapist in Private Practice 4981004124 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
California Luna Care Physical Therapy PCGroup PAC ID 9638427834, 769 clinicians

Practice addresses (Care Compare)

16185 Los Gatos Blvd
Suite 205
Los Gatos, CA 95032-4569
Phone (866) 525-3175

Merit-based Incentive Payment System (MIPS)

Final score
79.53 of 100Reported as individual
Quality
71.92
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
300196CAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
California Luna Care Physical Therapy PC Physical Therapist CurrentSince Dec 23, 2022 Accepting new patients

Locations

16185 Los Gatos Blvd
Ste 205
Los Gatos, CA 95032
Phone (408) 459-8108

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": "1622505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622505600000",
    "number": "1306412283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3959 RUFFIN RD STE J",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921231830",
            "telephone_number": "858-279-5570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8491 FLETCHER PKWY",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919423005",
            "telephone_number": "619-460-0137"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3959 Ruffin Rd Ste J",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921231830",
            "country_code": "US",
            "telephone_number": "858-279-5570",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VELASCO",
        "first_name": "JEREMY",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-06-01",
        "last_updated": "2021-06-01",
        "certification_date": "2021-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "300196",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in La Mesa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 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.