Individual provider Active NPI

Jayasree Dasari

  • Physical Therapist
  • Elkridge, MD
National Provider Identifier
1417626326
Registry record updated May 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
7280 Montgomery Rd Ste 470
Elkridge, MD 21075-9103
Phone
(443) 561-0893
NPI assigned
Sep 13, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 7, 2025

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 Primary

Addresses

Primary practice location

7280 Montgomery Rd Ste 470
Elkridge, MD 21075-9103

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler Other Fox Rehabilitation Services LLC

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
27819MDMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Fox Rehab PT MD LLC Physical Therapist CurrentSince Dec 1, 2024 Accepting new patients
Ati Holdings, LLC Physical Therapist CurrentSince Sep 13, 2021 Accepting new patients
Ati Holdings, LLC Physical Therapist CurrentSince Sep 13, 2021 Accepting new patients
Fox Rehabilitation Services LLC Physical Therapist CurrentSince Dec 1, 2024 Accepting new patients
Ati Holdings, LLC PastSince Sep 23, 2021 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

4947 Paysphere Cir
Chicago, IL 60674
Phone (630) 783-2001

1510 Rock Spring Rd
Ste C
Forest Hill, MD 21050
Phone (410) 420-3619

52 Rising Sun Town Ctr
Rising Sun, MD 21911
Phone (410) 658-0100

11665 Doolittle Dr
Waldorf, MD 20602
Phone (301) 638-4100

7 Carnegie Plz
Cherry Hill, NJ 08003

Organizations & group practices 5

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": "1631491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746576000000",
    "number": "1417626326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7280 MONTGOMERY RD STE 470",
            "city": "ELKRIDGE",
            "state": "MD",
            "postal_code": "210759103",
            "telephone_number": "443-561-0893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DASARI",
        "first_name": "JAYASREE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-09-13",
        "last_updated": "2025-05-07",
        "certification_date": "2025-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.cms.gov/research-statistics-data-systems/electronic-submission-medical-documentation-esmd/cms-health-information-handler",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.13.34.110.1.998.01",
            "affiliationName": "Fox Rehabilitation Services LLC",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "9885 Greenbelt Rd",
            "city": "Lanham",
            "state": "MD",
            "country_code": "US",
            "postal_code": "207062302",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Elkridge, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2025; 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.