Individual provider Active NPI

Alexandra Denise Jimenez, DPT

  • Physical Therapist
  • Waldorf, MD
National Provider Identifier
1376272997
Registry record updated Apr 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
28976 Issued in MD
Practice address
3320 Crain Hwy
Waldorf, MD 20603-4850
Phone
(301) 870-7366
NPI assigned
Jun 8, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2024

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 28976 MD Primary

Addresses

Primary practice location

3320 Crain Hwy
Waldorf, MD 20603-4850

Mailing address

3320 Crain Hwy
Waldorf, MD 20603-4850
Phone (301) 870-7366

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20221007001885 MD Practitioner - Physical Therapist in Private Practice 4587040928 Reassigns benefits to 1 organization
I20230929000008 DC Practitioner - Physical Therapist in Private Practice 4587040928 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Proflex Physical Therapy of Maryland, LLCGroup PAC ID 7416244322, 41 clinicians

Practice addresses (Care Compare)

3320 Crain Hwy
Waldorf, MD 20603-4850
Phone (301) 870-7366

7905 Malcolm Rd
Suite 201
Clinton, MD 20735-1749
Phone (301) 856-0050

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
28976MDMDSocial Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Proflex Physical Thearpy of Maryland, LLC CurrentSince Sep 27, 2022 Accepting new patients
Proflex Physical Therapy of Maryland, LLC. Physical Therapist CurrentSince Sep 27, 2022 Accepting new patients

Locations

7905 Malcolm Rd
Ste 201
Clinton, MD 20735
Phone (301) 856-0050

3320 Crain Hwy
Waldorf, MD 20603
Phone (301) 870-7366

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": "1654646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712880000000",
    "number": "1376272997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3320 CRAIN HWY",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034850",
            "telephone_number": "301-870-7366"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3320 CRAIN HWY",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034850",
            "telephone_number": "301-870-7366"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JIMENEZ",
        "first_name": "ALEXANDRA",
        "middle_name": "DENISE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-08",
        "last_updated": "2024-04-12",
        "certification_date": "2024-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "28976",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waldorf, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 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.