Individual provider Active NPI

Thomas Jeremy Priest

  • Physical Therapy Assistant
  • Greenwood, AR
National Provider Identifier
1366084451
Registry record updated Oct 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
License
4474 Issued in AR
Practice address
618 W Center St
Greenwood, AR 72936-4605
Phone
(479) 996-2525
NPI assigned
Oct 10, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X 4474 AR Primary

Addresses

Primary practice location

618 W Center St
Greenwood, AR 72936-4605

Mailing address

40 Tok JCT
Oden, AR 71961-8148
Phone (479) 234-1147

Other practice location 1

40 Tok Jct
Oden, AR 71961-8148
Phone (479) 234-1147

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
4474ARMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
MCL Therapy LLC CurrentSince Oct 13, 2019 Accepting new patients
Bohannan Irgens Group LLC PastSince Oct 13, 2019 Accepting new patients

Locations

618 W Center St
Greenwood, AR 72936
Phone (479) 996-2525

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": "1570665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1570665600000",
    "number": "1366084451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 TOK JCT",
            "city": "ODEN",
            "state": "AR",
            "postal_code": "719618148",
            "telephone_number": "479-234-1147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "618 W CENTER ST",
            "city": "GREENWOOD",
            "state": "AR",
            "postal_code": "729364605",
            "telephone_number": "479-996-2525"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "40 Tok Jct",
            "address_purpose": "LOCATION",
            "city": "Oden",
            "state": "AR",
            "postal_code": "719618148",
            "country_code": "US",
            "telephone_number": "479-234-1147",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRIEST",
        "first_name": "THOMAS",
        "middle_name": "JEREMY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-10-10",
        "last_updated": "2019-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "AR",
            "license": "4474",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenwood, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2019; 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.