Active NPI
Otto Dunker, PT
- Physical Therapist
- Roxbury, MA
National Provider Identifier
1578720652
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 13221
- Practice address
- 50 Blue Hill Ave
Roxbury, MA 02119-3321 - Phone
- (617) 989-8822
- NPI assigned
- May 17, 2008
- Sex
- Male
- Sole proprietor
- Yes
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 | 13221 | MA | Primary |
Addresses
Primary practice location
50 Blue Hill Ave
Roxbury, MA 02119-3321
Mailing address
50 Blue Hill Ave
Roxbury, MA 02119-3321
Phone (617) 989-8822
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120522000742 | MA | Practitioner - Physical Therapist in Private Practice | 4082887567 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Ownership & related parties
All facility ownership & control disclosures 1
Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.
| Facility | Type | Role | Since |
|---|---|---|---|
| Blue Hills Therapeutics Inc. | Home health agency | 5% Or Greater Direct Ownership Interest (100%) Corporate Officer (100%) W-2 Managing Employee (100%) |
May 12, 2009 May 12, 2009 May 12, 2009 |
Owned or controlled facilities with NPI records 1
Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.
-
- Home Health Agency
- Forestdale, MA
- NPI 1518195015
5% Or Greater Direct Ownership Interest, Corporate Officer, W-2 Managing Employee
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210982400000",
"number": "1578720652",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "50 BLUE HILL AVE",
"city": "ROXBURY",
"state": "MA",
"postal_code": "021193321",
"telephone_number": "617-989-8822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "50 BLUE HILL AVE",
"city": "ROXBURY",
"state": "MA",
"postal_code": "021193321",
"telephone_number": "617-989-8822"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DUNKER",
"first_name": "OTTO",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-17",
"last_updated": "2008-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "13221",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roxbury, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.