Active NPI
Jeffrey A Thomason, PT
- Physical Therapist
- Caldwell, ID
National Provider Identifier
1538253752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT 832
- Practice address
- 3410 Blaine St
#101
Caldwell, ID 83605 - Phone
- (208) 455-9826
- Fax
- (208) 459-1626
- NPI assigned
- Oct 3, 2006
- Last updated
- Jul 8, 2007
- 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 | PT 832 | ID | Primary |
Addresses
Primary practice location
3410 Blaine St
#101
Caldwell, ID 83605
Mailing address
PO Box 711185
Salt Lake City, UT 84171
Phone (801) 942-3311
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0027023000 | Medicaid | ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
4623 Enterprise Way
Caldwell, ID 83605-6764
Phone (208) 455-4231
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT 832 | ID | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mountain Land Rehabilitation LLC | Physical Therapist | Current | Accepting new patients |
Locations
4623 Enterprise Way
Caldwell, ID 83605
Phone (208) 455-4231
1800 Flandro Dr
Ste 190
Pocatello, ID 83202
Phone (208) 233-2248
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1538253752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 711185",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "84171",
"telephone_number": "801-942-3311",
"fax_number": "801-942-5955"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3410 BLAINE ST",
"address_2": "#101",
"city": "CALDWELL",
"state": "ID",
"postal_code": "83605",
"telephone_number": "208-455-9826",
"fax_number": "208-459-1626"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMASON",
"first_name": "JEFFREY",
"middle_name": "A",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "ID",
"license": "PT 832",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0027023000",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Caldwell, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.