Individual provider Active NPI

Jonathan Dale Ke, PT, DPT

  • Physical Therapist
  • Norcross, GA
National Provider Identifier
1447896501
Registry record updated May 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT014414 Issued in GA
Practice address
4505 Peachtree Industrial Blvd.
Suite K
Norcross, GA 30092
Phone
(678) 446-1835
NPI assigned
Nov 25, 2019
Last updated
May 2, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2022

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 PT014414 GA Primary

Addresses

Primary practice location

4505 Peachtree Industrial Blvd.
Suite K
Norcross, GA 30092

Mailing address

4505 Peachtree Industrial Blvd.
Suite K
Norcross, GA 30092
Phone (678) 446-1835

Other practice location 1

4790 Peachtree Industrial Blvd Ste 106
Berkeley Lake, GA 30071-5723
Phone (678) 718-5240

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200113000779 GA Practitioner - Physical Therapist in Private Practice 6709211188 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4505 Peachtree Industrial Blvd
Berkeley Lake, GA 30092-3000
Phone (678) 532-9188

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT014414GAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Newcare Physical Therapy, LLC CurrentSince Dec 1, 2019 Accepting new patients

Locations

4790 Peachtree Industrial Blvd
Ste 106
Berkeley Lake, GA 30071
Phone (678) 718-5240

1120 Peachtree Industrial Blvd
Ste 207
Suwanee, GA 30024
Phone (678) 718-5240

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, 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": "1574640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651449600000",
    "number": "1447896501",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4505 PEACHTREE INDUSTRIAL BLVD.",
            "address_2": "SUITE K",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "30092",
            "telephone_number": "678-446-1835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4505 PEACHTREE INDUSTRIAL BLVD.",
            "address_2": "SUITE K",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "30092",
            "telephone_number": "678-446-1835"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4790 Peachtree Industrial Blvd Ste 106",
            "address_purpose": "LOCATION",
            "city": "Berkeley Lake",
            "state": "GA",
            "postal_code": "300715723",
            "country_code": "US",
            "telephone_number": "678-718-5240",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KE",
        "first_name": "JONATHAN",
        "middle_name": "DALE",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-25",
        "last_updated": "2022-05-02",
        "certification_date": "2022-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT014414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norcross, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2022; 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.