Jack Prince

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

307349 Issued in CA

Practice address

20823 Stevens Creek Blvd Ste 200
Cupertino, CA 95014-2112

Phone

(408) 252-6076

NPI assigned

Feb 12, 2025

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southern Mono Health Care DistrictGroup PAC ID 9830002401, 94 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jack.prince.1@19661.direct.athenahealth.com

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.

• Southern Mono Health Care District

  • Critical Access Hospital Clinic/Center
  • Mammoth Lakes, CA
  • NPI 1962444059
  Medicare reassignment Care Compare group
• Quinn Orthopedic Physical Therapy

  • Physical Therapy Clinic/Center
  • Cupertino, CA
  • NPI 1568506178

  Physical Therapist

  Medicare reassignment NPD

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

{
    "created_epoch": "1739318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739318400000",
    "number": "1376358671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20823 STEVENS CREEK BLVD STE 200",
            "city": "CUPERTINO",
            "state": "CA",
            "postal_code": "950142112",
            "telephone_number": "408-252-6076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20823 STEVENS CREEK BLVD STE 200",
            "city": "CUPERTINO",
            "state": "CA",
            "postal_code": "950142112",
            "telephone_number": "408-252-6076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRINCE",
        "first_name": "JACK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-02-12",
        "last_updated": "2025-02-12",
        "certification_date": "2025-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "307349",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fiona Poon
• Kelly Poon
• Ioana Popescu, M.D.
• Mariah S Powell, HIGH SCHOOL DIPLOMA
• Aneetha Prabhakar
• Tina Prothro-Jones, PT
• Erin Prues, CMT
• Lou Prusa, D.D.S.
• PT in Motion
• Chunyu Pu, PH.D.

• Physical Therapist in Cupertino, CA
• Providers in Cupertino, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2025; 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.