Active NPI
Jose Nephtali Guevarra, PT
- Physical Therapist
- Hartsville, SC
National Provider Identifier
1518996339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 3280
- Practice address
- 107 N 8TH St
Hartsville, SC 29550 - Phone
- (843) 857-4343
- Fax
- (843) 857-4345
- NPI assigned
- Jul 2, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 3280 | SC | Primary |
Addresses
Primary practice location
107 N 8TH St
Hartsville, SC 29550
Mailing address
107 N 8TH St
Hartsville, SC 29550
Phone (843) 857-4343
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| TH1694 | Medicaid | SC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050111000217 | SC | Practitioner - Physical Therapist in Private Practice | 6406804004 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3280 | SC | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151798400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192579200000",
"number": "1518996339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 N 8TH ST",
"city": "HARTSVILLE",
"state": "SC",
"postal_code": "29550",
"telephone_number": "843-857-4343",
"fax_number": "843-857-4345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 N 8TH ST",
"city": "HARTSVILLE",
"state": "SC",
"postal_code": "29550",
"telephone_number": "843-857-4343",
"fax_number": "843-857-4345"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUEVARRA",
"first_name": "JOSE",
"middle_name": "NEPHTALI",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-02",
"last_updated": "2007-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "SC",
"license": "3280",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "TH1694",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hartsville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.