Individual provider Active NPI

Nicole Dacquisto, PT

  • Sports Physical Therapist
  • Atherton, CA
National Provider Identifier
1639299365
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physical TherapistTaxonomy code 2251S0007X
License
PT28642 Issued in CA
Practice address
3351 El Camino Real
Suite 180
Atherton, CA 94027-3811
Phone
(650) 365-8350
Fax
(650) 368-8353
NPI assigned
Mar 29, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physical Therapist 2251S0007X PT28642 CA Primary

Addresses

Primary practice location

3351 El Camino Real
Suite 180
Atherton, CA 94027-3811

Mailing address

3351 El Camino Real
Suite 180
Atherton, CA 94027-3811
Phone (650) 365-8350

Other identifiers 1

IdentifierTypeStateIssuer
PT28642OtherCAPT LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040625000752 CA Practitioner - Physical Therapist in Private Practice 2264418789 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Barman and Sargent IncGroup PAC ID 2163317025, 15 clinicians

Practice addresses (Care Compare)

315 Diablo Rd
Danville, CA 94526-3409
Phone (925) 855-8343

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
PT28642CAMDSports Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Barman & Sargent Inc CurrentSince Oct 1, 2003 Accepting new patients
Barman & Sargent Inc Sports CurrentSince Oct 1, 2003 Accepting new patients

Locations

3351 El Camino Real
Ste 180
Atherton, CA 94027
Phone (650) 365-8350

315 Diablo Rd
Ste 110
Danville, CA 94526
Phone (925) 855-8343

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1639299365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3351 EL CAMINO REAL",
            "address_2": "SUITE 180",
            "city": "ATHERTON",
            "state": "CA",
            "postal_code": "940273811",
            "telephone_number": "650-365-8350",
            "fax_number": "650-368-8353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3351 EL CAMINO REAL",
            "address_2": "SUITE 180",
            "city": "ATHERTON",
            "state": "CA",
            "postal_code": "940273811",
            "telephone_number": "650-365-8350",
            "fax_number": "650-368-8353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DACQUISTO",
        "first_name": "NICOLE",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "CA",
            "license": "PT28642",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PT LICENSE",
            "identifier": "PT28642",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atherton, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.