Individual provider Active NPI

Jerod Allan Sharp

  • Physical Therapist
  • Wichita, KS
National Provider Identifier
1578859740
Registry record updated Mar 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
PT-2898 Issued in ID
Practice address
3460 N Ridge Rd Ste 80
Wichita, KS 67205-1223
Phone
(316) 202-0340
NPI assigned
Jun 24, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 17, 2018

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 PT-2898 ID Primary

Addresses

Primary practice location

3460 N Ridge Rd Ste 80
Wichita, KS 67205-1223

Mailing address

200 W Douglas Ave Ste 1040
Wichita, KS 67202-3017
Phone (316) 263-0003

Other practice location 1

229 S 7th St
St Maries, ID 83861-1803
Phone (208) 245-7040

Other practice location 2

229 S 7th St
St Maries, ID 83861-1803
Phone (208) 245-7040

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220309001866 WY Practitioner - Physical Therapist in Private Practice 3577715929 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advantage RehabGroup PAC ID 4587577507, 11 clinicians

Practice addresses (Care Compare)

1819 Sheridan Ave
Cody, WY 82414-3886
Phone (307) 587-9866

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT-2898IDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Mountain Peak Performance Physical Therapist Current Accepting new patients
Northwest Center for Sports Medicine & Physical Therapy, Inc. Physical Therapist CurrentSince Jul 29, 2019 Accepting new patients
Advantage Rehab Physical Therapist CurrentSince Mar 28, 2022 Accepting new patients
Rebound Physical Therapy at Wood Valley Physical Therapist Past Accepting new patients
Advanced PT, LLC PastSince Sep 25, 2017 Accepting new patients

Locations

4303 W 24th Ave
Ste B
Kennewick, WA 99338
Phone (509) 416-0444

6825 Burden Blvd
Ste D
Pasco, WA 99301
Phone (509) 416-0444

1020 Queensgate Dr
Richland, WA 99352
Phone (509) 578-5100

1819 Sheridan Ave
Cody, WY 82414
Phone (307) 587-9866

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1308873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1578859740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 W DOUGLAS AVE STE 1040",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672023017",
            "telephone_number": "316-263-0003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3460 N RIDGE RD STE 80",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672051223",
            "telephone_number": "316-202-0340"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "229 S 7th St",
            "address_purpose": "LOCATION",
            "city": "St Maries",
            "state": "ID",
            "postal_code": "838611803",
            "country_code": "US",
            "telephone_number": "208-245-7040",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "229 S 7th St",
            "address_purpose": "LOCATION",
            "city": "St Maries",
            "state": "ID",
            "postal_code": "838611803",
            "country_code": "US",
            "telephone_number": "208-245-7040",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHARP",
        "first_name": "JEROD",
        "middle_name": "ALLAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-06-24",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "ID",
            "license": "PT-2898",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.