Individual provider Active NPI

Nathan James Aultman, PT

  • Physical Therapist
  • Shreveport, LA
National Provider Identifier
1629692074
Registry record updated Jun 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
10588 Issued in LA
Practice address
1800 Buckner St Ste C249
Shreveport, LA 71101-4447
Phone
(318) 934-1969
Fax
(318) 934-1960
NPI assigned
Jun 2, 2020
Last updated
Jun 2, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 2, 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 10588 LA Primary

Addresses

Primary practice location

1800 Buckner St Ste C249
Shreveport, LA 71101-4447

Mailing address

PO Box 1377
West Monroe, LA 71294-1377
Phone (318) 396-1969

Other identifiers 1

IdentifierTypeStateIssuer
10588OtherLALA LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200608003049 LA Practitioner - Physical Therapist in Private Practice 4082035506 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Melanie Massey Physical Therapy IncGroup PAC ID 5890784342, 24 clinicians

Practice addresses (Care Compare)

107 Summer LN
West Monroe, LA 71291-3501
Phone (318) 396-1969

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Melanie Massey Physical Therapy Inc Physical Therapist CurrentSince Jun 11, 2020 Accepting new patients
Melanie Massey Infant & Toddler LLC Physical Therapist PastSince Jun 7, 2020 Accepting new patients

Locations

3177 Sterlington Rd
Monroe, LA 71203
Phone (318) 388-1989

1800 Buckner St
Ste C249
Shreveport, LA 71101
Phone (318) 934-1969

107 Summer Ln
West Monroe, LA 71291
Phone (318) 396-1969

Organizations & group practices 2

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": "1591056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591056000000",
    "number": "1629692074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1377",
            "city": "WEST MONROE",
            "state": "LA",
            "postal_code": "712941377",
            "telephone_number": "318-396-1969",
            "fax_number": "318-396-1970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 BUCKNER ST STE C249",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014447",
            "telephone_number": "318-934-1969",
            "fax_number": "318-934-1960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AULTMAN",
        "first_name": "NATHAN",
        "middle_name": "JAMES",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-02",
        "last_updated": "2020-06-02",
        "certification_date": "2020-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "LA",
            "license": "10588",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LA LICENSE",
            "identifier": "10588",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 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.