Individual provider Active NPI

Jenna Lynn Gourlay, DPT

  • Physical Therapist
  • Evansville, IN
National Provider Identifier
1528472131
Registry record updated Jun 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
225 Crosslake Dr
Evansville, IN 47715-8198
Phone
(812) 471-6677
Fax
(812) 474-2296
NPI assigned
Jun 12, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2021

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 IN Primary

Addresses

Primary practice location

225 Crosslake Dr
Evansville, IN 47715-8198

Mailing address

7300 E Indiana St
Suite 102
Evansville, IN 47715-2794
Phone (812) 476-0409

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140701002087 IN Practitioner - Physical Therapist in Private Practice 7012132202 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rehabilitation and Performance Institute PSCGroup PAC ID 8729379888, 36 clinicians

Practice addresses (Care Compare)

425 B W Jennings St
Newburgh, IN 47630-1113
Phone (812) 518-3246

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Tri-State Orthopaedic Surgeons, Inc. CurrentSince Jul 1, 2014 Accepting new patients
Rehabilitation and Performance Institute PSC Physical Therapist CurrentSince May 1, 2021 Accepting new patients
Tri-State Orthopaedic Surgeons, Inc. CurrentSince Jul 1, 2014 Accepting new patients

Locations

210 S 7th St
Petersburg, IL 62675
Phone (618) 852-3100

225 Crosslake Dr
Evansville, IN 47715
Phone (812) 471-6677

1927 W Franklin St
Evansville, IN 47712
Phone (812) 250-9828

7300 E Indiana St
Ste 102
Evansville, IN 47715
Phone (812) 759-7451

526 E 4th St
Mount Vernon, IN 47620
Phone (270) 926-8145

425 W Jennings St
#B
Newburgh, IN 47630
Phone (812) 518-3246

8887 High Pointe Dr
Ste E
Newburgh, IN 47630
Phone (812) 759-7464

2121 Willow St
Vincennes, IN 47591
Phone (812) 882-1141

418 W 3rd St
Owensboro, KY 42301
Phone (270) 926-8145

Organizations & group practices 3

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": "1402531200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623196800000",
    "number": "1528472131",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 E INDIANA ST",
            "address_2": "SUITE 102",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477152794",
            "telephone_number": "812-476-0409",
            "fax_number": "812-476-1016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 CROSSLAKE DR",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477158198",
            "telephone_number": "812-471-6677",
            "fax_number": "812-474-2296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOURLAY",
        "first_name": "JENNA",
        "middle_name": "LYNN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-12",
        "last_updated": "2021-06-09",
        "certification_date": "2021-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2021; 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.