Jerrod Ackerman
Individual provider Active NPI Physical Therapist · Boise, ID
NPI 1487067005 · NPPES record last updated Dec 15, 2014
Key facts
- NPI
- 1487067005
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT-3702 (ID)
- Practice address
- 390 E Parkcenter Blvd
Ste. 130
Boise, ID 83706-6662 - Phone
- (208) 433-9211
- Fax
- (208) 433-9241
- NPI assigned
- Jun 11, 2014
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Rock and Armor Physical Therapy and Sports Performance, LLC
Practice addresses (Care Compare)
104 W 53Rd St
Garden City, ID 83714-3501
Phone (208) 917-2660
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140829001081 | ID | Practitioner - Physical Therapist in Private Practice | 2668690827 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT-3702 | ID | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Therapeutic Associates Inc | Physical Therapist | Current |
Accepting new patients |
| Rock and Armor Physical Therapy and Sports Performance, LLC | Physical Therapist | Current |
Accepting new patients |
| Therapeutic Associates Inc | Physical Therapist | Current | Accepting new patients |
| Therapeutic Associates Inc | Physical Therapist | Current |
Accepting new patients |
| Therapeutic Associates Inc | Physical Therapist | Past | Accepting new patients |
| Therapeutic Associates Inc | Physical Therapist | Past | Accepting new patients |
| Therapeutic Associates Inc | Physical Therapist | Past | Accepting new patients |
Locations
390 E Parkcenter Blvd
Ste 130
Boise, ID 83706
Phone (208) 433-9211
1520 W State St
Ste 210
Boise, ID 83702
Phone (208) 336-8433
104 W 53rd St
Garden City, ID 83714
Phone (208) 375-5511
1649 E Pine Ave
Meridian, ID 83642
Phone (208) 917-2660
16083 SW Upper Boones Ferry Rd
Ste 300
Tigard, OR 97224
Phone (503) 443-6153
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT-3702 | ID | Yes |
Addresses
Primary practice location
390 E Parkcenter Blvd
Ste. 130
Boise, ID 83706-6662
Mailing address
16083 SW Upper Boones Ferry Rd
Ste. 300
Tigard, OR 97224-7736
Phone (800) 219-8835
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0327602 | Other | ID | WA L&I |
| 0327604 | Other | ID | WA L&I |
| 1487067005 | Medicaid | ID | |
| 0330328 | Other | ID | WA L&I |
| 0327611 | Other | ID | WA L&I |
| 0327610 | Other | ID | WA L&I |
Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 15, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.