Individual provider Active NPI

Tomas Jelinek, PT

  • Physical Therapist
  • Sandusky, MI
National Provider Identifier
1508845819
Registry record updated Jul 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501004236 Issued in MI
Practice address
309 S Elk St
Sandusky, MI 48471
Phone
(810) 648-9626
Fax
(810) 648-9626
NPI assigned
Jan 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2007

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 5501004236 MI Primary

Addresses

Primary practice location

309 S Elk St
Sandusky, MI 48471

Mailing address

309 S Elk St
Sandusky, MI 48471
Phone (810) 648-9626

Other identifiers 2

IdentifierTypeStateIssuer
4676225OtherMIAETNA
3182480MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060301000117 MI Practitioner - Physical Therapist in Private Practice 0143236273 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

55 Pack St
Harbor Beach, MI 48441-1042
Phone (810) 648-9626

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5501004236MIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Hawk Associates Inc Physical Therapist CurrentSince Feb 1, 2006 Accepting new patients

Locations

55 Pack St
Harbor Beach, MI 48441
Phone (810) 648-9626

309 S Elk St
Sandusky, MI 48471
Phone (810) 648-9626

309 S Elk St
#1
Sandusky, MI 48471
Phone (810) 648-9626

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1137110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184630400000",
    "number": "1508845819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 S ELK ST",
            "city": "SANDUSKY",
            "state": "MI",
            "postal_code": "48471",
            "telephone_number": "810-648-9626",
            "fax_number": "810-648-9626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 S ELK ST",
            "city": "SANDUSKY",
            "state": "MI",
            "postal_code": "48471",
            "telephone_number": "810-648-9626",
            "fax_number": "810-648-9626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JELINEK",
        "first_name": "TOMAS",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-13",
        "last_updated": "2007-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501004236",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4676225",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3182480",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sandusky, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2007; 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.