Victor Jayasundera, RPT

Primary specialty

SpecialistTaxonomy code 174400000X

License

5501005927 Issued in MI

Practice address

23100 Providence Dr
Suite 135
Southfield, MI 48075-3646

Phone

(248) 905-5180

Fax

(248) 905-5181

NPI assigned

Mar 23, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Practice roles

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.

• Village Center Physical Therapy LLC

  • Physical Therapist
  • Southfield, MI
  • NPI 1427387497
  NPD (past) Authorized official

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

{
    "created_epoch": "1174608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1327536000000",
    "number": "1558488783",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23100 PROVIDENCE DR",
            "address_2": "SUITE 135",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480753646",
            "telephone_number": "248-905-5180",
            "fax_number": "248-905-5181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23100 PROVIDENCE DR",
            "address_2": "SUITE 135",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480753646",
            "telephone_number": "248-905-5180",
            "fax_number": "248-905-5181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAYASUNDERA",
        "first_name": "VICTOR",
        "credential": "RPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-23",
        "last_updated": "2012-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MI",
            "license": "5501005927",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "5501005927",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacob Michael Jasinski, DO
• Diana Jasser, TLLP
• Salar Javanshir Heidari, MD
• Aneela Javeed
• Rasha Jawad
• JC Transportation Services LLC
• Elena N Jdanova, M.D.
• Phoebee Jean
• Jeanette'S Home LLC
• Julian Jeberaeel

• Specialist in Southfield, MI
• Providers in Southfield, MI by specialty
• Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.