Jeremy Shakouri Wydra

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

PT39007 Issued in FL

Practice address

4040 Winter Garden Vineland Rd
Winter Garden, FL 34787-9502

Phone

(407) 573-3361

Fax

(407) 395-8309

NPI assigned

Jul 20, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

The University of Central Florida Board of TrusteesGroup PAC ID 9739181470, 43 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

79.91 of 100Reported as group

Quality

61.18

Promoting interoperability

100

Improvement activities

40

Cost

71.86

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network

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.

• The University of Central Florida Board of Trustees

  • Speech-Language Pathologist
  • Orlando, FL
  • NPI 1568497527
  Medicare reassignment Care Compare group
• Florida Luna Care Physical Therapy LLC

  • Physical Therapist
  • Jacksonville, FL
  • NPI 1114542032
  Medicare reassignment NPD
• Orlando Health Medical Group Inc

  • Internal Medicine Physician
  • Orlando, FL
  • NPI 1669429577
  Medicare reassignment NPD
• Orlando Health Medical Group Inc

  • Durable Medical Equipment & Medical Supplies
  • Winter Park, FL
  • NPI 1265019541
  NPD
• True Sports Physical Therapy 2, LLC

  • Physical Therapy Clinic/Center
  • Woodbine, MD
  • NPI 1023539178
  NPD (past)

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

{
    "created_epoch": "1658275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686096000000",
    "number": "1497480792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4040 WINTER GARDEN VINELAND RD",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347879502",
            "telephone_number": "407-573-3361",
            "fax_number": "407-395-8309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4040 WINTER GARDEN VINELAND RD",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347879502",
            "telephone_number": "407-573-3361",
            "fax_number": "407-395-8309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYDRA",
        "first_name": "JEREMY",
        "middle_name": "SHAKOURI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-20",
        "last_updated": "2023-06-07",
        "certification_date": "2023-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "29148",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "FL",
            "license": "PT39007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Delaney Sharp Woodward
• Wendi Woollens, CD, CLC
• Janice Louise Wooten, OTR
• Desiree Wootson
• Darren Wright I
• Angelica Maria Wyman, DNP, AGACNP
• Tanja Nazzal Wysocki, FNP
• Matthew B Yampolsky, MS, ATC, LAT
• Adriana Yates Munar, MD
• Daniel Yee, PHARMD

• Orthopedic Physical Therapist in Winter Garden, FL
• Providers in Winter Garden, FL by specialty
• Orthopedic Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2023; 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.