Active NPI
Jack Gillingham, PT, DPT
- Orthopedic Physical Therapist
- Talent, OR
National Provider Identifier
1548090004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthopedic Physical Therapist
- License
- 65317
- Practice address
- 288 S Pacific Hwy
Talent, OR 97540-6649 - Phone
- (541) 482-6360
- NPI assigned
- Aug 7, 2024
- 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 |
|---|---|---|---|---|
| Orthopedic Physical Therapist | 2251X0800X | 65317 | OR | Primary |
Addresses
Primary practice location
288 S Pacific Hwy
Talent, OR 97540-6649
Mailing address
36 Hawthorne St
Medford, OR 97504-7114
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241014002231 | OR | Practitioner - Physical Therapist in Private Practice | 0749712990 | Reassigns benefits to 1 organization |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 65317 | OR | MD | Orthopedic Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jackson County Physical Therapy LLP | Orthopedic | Current | Accepting new patients |
Locations
36 Hawthorne St
Medford, OR 97504
Phone (541) 776-2333
288 S Pacific Hwy
Talent, OR 97540
Phone (541) 482-6360
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": "1722988800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722988800000",
"number": "1548090004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "36 HAWTHORNE ST",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975047114"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "288 S PACIFIC HWY",
"city": "TALENT",
"state": "OR",
"postal_code": "975406649",
"telephone_number": "541-482-6360"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLINGHAM",
"first_name": "JACK",
"name_prefix": "Dr.",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-08-07",
"last_updated": "2024-08-07",
"certification_date": "2024-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "2251X0800X",
"taxonomy_group": "",
"desc": "Physical Therapist, Orthopedic",
"state": "OR",
"license": "65317",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Talent, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2024; 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.