Individual provider Active NPI

Theodore John Kepros, PT

  • Orthopedic Physical Therapist
  • Mount Vernon, IA
National Provider Identifier
1639274228
Registry record updated Sep 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
02336 Issued in IA
Practice address
108 1St St SE
Mount Vernon, IA 52314-1465
Phone
(319) 895-4085
Fax
(319) 895-8013
NPI assigned
Sep 14, 2006
Last updated
Sep 3, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopedic Physical Therapist 2251X0800X 02336 IA Primary

Addresses

Primary practice location

108 1St St SE
Mount Vernon, IA 52314-1465

Mailing address

108 1St St SE
Mount Vernon, IA 52314-1465
Phone (319) 895-4085

Other identifiers 1

IdentifierTypeStateIssuer
0665430MedicaidIA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091028000045 IA Practitioner - Physical Therapist in Private Practice 3476541889 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kepros Physical Therapy and Performance PCGroup PAC ID 7719105063, 19 clinicians

Practice addresses (Care Compare)

218 4TH Ave SW
Cedar Rapids, IA 52404-5720
Phone (319) 200-6102

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Kepros Physical Therapy and Performance, P.C. Orthopedic CurrentSince Sep 1, 2014 Accepting new patients
Iowa Physical Therapy PC Past Accepting new patients

Locations

218 4th Ave SW
Cedar Rapids, IA 52404
Phone (319) 200-6102

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": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378166400000",
    "number": "1639274228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 1ST ST SE",
            "city": "MOUNT VERNON",
            "state": "IA",
            "postal_code": "523141465",
            "telephone_number": "319-895-4085",
            "fax_number": "319-895-8013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 1ST ST SE",
            "city": "MOUNT VERNON",
            "state": "IA",
            "postal_code": "523141465",
            "telephone_number": "319-895-4085",
            "fax_number": "319-895-8013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEPROS",
        "first_name": "THEODORE",
        "middle_name": "JOHN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2013-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "IA",
            "license": "02336",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0665430",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2013; 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.