Active NPI
Jerry Lynn Hopper, RPT
- Physical Therapist
- Barstow, CA
National Provider Identifier
1629014063
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT13643
- Practice address
- 1815 E Main St
Barstow, CA 92311-3234 - Phone
- (760) 256-2800
- Fax
- (760) 256-2809
- NPI assigned
- Jun 22, 2006
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT13643 | CA | Primary |
Addresses
Primary practice location
1815 E Main St
Barstow, CA 92311-3234
Mailing address
1815 E Main St
Barstow, CA 92311-3234
Phone (760) 256-2800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PT13643 | Other | CA | PHYSICAL THERAPY LICENSE |
Other names 1
- Mr. Jerry L. Hopper
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT13643 | CA | MD | Physical Therapist |
| 1234 | CA | MD | Prevention Professional |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| P and a Health Services | Physical Therapist | Current | Accepting new patients |
| RPM Rebah, Inc | Physical Therapist | Past | Accepting new patients |
| PT Plus Rehab, Inc | Physical Therapist | Past | Accepting new patients |
Locations
24 Hammond
Ste C
Irvine, CA 92618
Phone (949) 770-6022
14566 Seventh St
Victorville, CA 92395
Phone (760) 843-0895
Organizations & group practices 3
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.
-
- Physical Therapy Clinic/Center
- Victorville, CA
- NPI 1104041144
Physical Therapist
-
- Physical Therapist
- Brentwood, TN
- NPI 1487088530
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150934400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302048000000",
"number": "1629014063",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1815 E MAIN ST",
"city": "BARSTOW",
"state": "CA",
"postal_code": "923113234",
"telephone_number": "760-256-2800",
"fax_number": "760-256-2809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1815 E MAIN ST",
"city": "BARSTOW",
"state": "CA",
"postal_code": "923113234",
"telephone_number": "760-256-2800",
"fax_number": "760-256-2809"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOPPER",
"first_name": "JERRY",
"middle_name": "LYNN",
"name_prefix": "Mr.",
"credential": "RPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-22",
"last_updated": "2011-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT13643",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICAL THERAPY LICENSE",
"identifier": "PT13643",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JERRY",
"last_name": "HOPPER",
"middle_name": "L.",
"prefix": "MR.",
"credential": "PT B.S.",
"code": "2",
"type": "Professional Name"
}
]
}
Other providers in Barstow, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.