Individual provider Active NPI

Alyssa Juarez, DPT

  • Physical Therapist
  • Norman, OK
National Provider Identifier
1417304247
Registry record updated Jan 11, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5117 Issued in OK
Practice address
2475 Boardwalk
Norman, OK 73069-6332
Phone
(405) 447-1991
NPI assigned
May 23, 2016
Last updated
Jan 11, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2017

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 5117 OK Primary

Addresses

Primary practice location

2475 Boardwalk
Norman, OK 73069-6332

Mailing address

3317 Green Wing CT
Oklahoma City, OK 73120-5013

Other identifiers 2

IdentifierTypeStateIssuer
200643840AMedicaidOK
5117OtherOKSTATE LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160714000847 OK Practitioner - Physical Therapist in Private Practice 1254623085 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ascent Physical Therapy and Performance LLCGroup PAC ID 0648513234, 2 clinicians

Practice addresses (Care Compare)

16325 N May Ave
Suite A4
Edmond, OK 73013-9142
Phone (405) 900-6503

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5117OKMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ascent Physical Therapy and Performance LLC Physical Therapist CurrentSince Mar 9, 2020 Accepting new patients

Locations

16325 N May Ave
Ste A4
Edmond, OK 73013
Phone (405) 900-6503

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1463961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484092800000",
    "number": "1417304247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3317 GREEN WING CT",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731205013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2475 BOARDWALK",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730696332",
            "telephone_number": "405-447-1991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JUAREZ",
        "first_name": "ALYSSA",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-05-23",
        "last_updated": "2017-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "OK",
            "license": "5117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200643840A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "5117",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norman, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2017; 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.