Jackson D Davenport, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

05014727A Issued in IN

Practice address

9950 Calumet Ave
Munster, IN 46321-4028

Phone

(219) 934-2840

Fax

(219) 934-2841

NPI assigned

Jul 11, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Munster Radiology Group PC

  • Diagnostic Radiology Physician
  • Munster, IN
  • NPI 1144207101
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664150400000",
    "number": "1376277905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8558 BROADWAY",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464107032",
            "telephone_number": "219-392-7084",
            "fax_number": "219-703-6854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9950 CALUMET AVE",
            "city": "MUNSTER",
            "state": "IN",
            "postal_code": "463214028",
            "telephone_number": "219-934-2840",
            "fax_number": "219-934-2841"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8840 Calumet Ave Ste 103",
            "address_purpose": "LOCATION",
            "city": "Munster",
            "state": "IN",
            "postal_code": "463212546",
            "country_code": "US",
            "telephone_number": "219-703-2416",
            "fax_number": "219-703-6778",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1545 W US Highway 30",
            "address_purpose": "LOCATION",
            "city": "Schererville",
            "state": "IN",
            "postal_code": "463751562",
            "country_code": "US",
            "telephone_number": "219-836-5381",
            "fax_number": "219-836-4466",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1545 W US Highway 30",
            "address_purpose": "LOCATION",
            "city": "Schererville",
            "state": "IN",
            "postal_code": "463751562",
            "country_code": "US",
            "telephone_number": "219-440-5360",
            "fax_number": "219-440-5361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVENPORT",
        "first_name": "JACKSON",
        "middle_name": "D",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-07-11",
        "last_updated": "2022-09-26",
        "certification_date": "2022-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05014727A",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070026760",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel R. Roque PT, P.C.
• Marquita Daniel, BCHHP
• Giancarlo Danno
• Andrea Darrol
• Satish Dasari, M.D.
• David Ashbach MD PC
• Darija Davila
• Wafa Dawahir, MD
• Derek J Dawson, M.D.
• Jin Dawson

• Physical Therapist in Munster, IN
• Providers in Munster, IN by specialty
• Physical Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2022; 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.