Individual provider Active NPI

Jonathan Thomas Suttles, MSPT

  • Physical Therapist
  • Ellensburg, WA
National Provider Identifier
1558489146
Registry record updated May 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT00006580 Issued in WA
Practice address
722 E University Way
Ellensburg, WA 98926-2947
Phone
(509) 962-1553
Fax
(509) 962-1554
NPI assigned
Mar 26, 2007
Last updated
May 13, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2020

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 PT00006580 WA Primary

Addresses

Primary practice location

722 E University Way
Ellensburg, WA 98926-2947

Mailing address

PO Box 2689
Wenatchee, WA 98807-2689
Phone (509) 260-1051

Other identifiers 3

IdentifierTypeStateIssuer
162229OtherWALABOR & INDUSTRIES
8344749MedicaidWA
98725SUOtherWAREGENCE BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080506000142 WA Practitioner - Physical Therapist in Private Practice 4880627660 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10207 19TH Ave SE
Everett, WA 98208-4257
Phone (425) 337-3166

722 E University Way
Ellensburg, WA 98926-2947
Phone (509) 962-1553

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT00006580WAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Integrated Rehabilitation Group, PC Physical Therapist CurrentSince Jun 1, 2023 Accepting new patients
Integrated Rehabilitation Group, PC Physical Therapist CurrentSince Jun 1, 2023 Accepting new patients
Central Washington Physical Therapy Physical Therapist PastSince Apr 30, 2003 Accepting new patients

Locations

875 Wesley St
Ste 220
Arlington, WA 98223
Phone (425) 337-3166

722 E University Way
Ellensburg, WA 98926
Phone (509) 962-1533

10207 19th Ave SE
Everett, WA 98208
Phone (425) 337-3166

403 W Stanley St
Granite Falls, WA 98252
Phone (360) 691-4835

4220 132nd St SE
Ste 101
Mill Creek, WA 98012
Phone (425) 316-8046

Organizations & group practices 5

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": "1174867200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589328000000",
    "number": "1558489146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2689",
            "city": "WENATCHEE",
            "state": "WA",
            "postal_code": "988072689",
            "telephone_number": "509-260-1051",
            "fax_number": "888-538-7694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "722 E UNIVERSITY WAY",
            "city": "ELLENSBURG",
            "state": "WA",
            "postal_code": "989262947",
            "telephone_number": "509-962-1553",
            "fax_number": "509-962-1554"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTTLES",
        "first_name": "JONATHAN",
        "middle_name": "THOMAS",
        "credential": "MSPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-26",
        "last_updated": "2020-05-13",
        "certification_date": "2020-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT00006580",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "162229",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8344749",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "98725SU",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellensburg, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2020; 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.