Active NPI
Jason William Anderson, PT
- Physical Therapist
- Costa Mesa, CA
National Provider Identifier
1639319924
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 28877
- Practice address
- 1640 Newport Blvd
Suite 220
Costa Mesa, CA 92627-3786 - Phone
- (949) 650-4362
- NPI assigned
- Feb 25, 2009
- Sex
- Male
- Sole proprietor
- Yes
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 | 28877 | CA | Primary |
Addresses
Primary practice location
1640 Newport Blvd
Suite 220
Costa Mesa, CA 92627-3786
Mailing address
4704 Seashore Dr
Apt B
Newport Beach, CA 92663-2524
Phone (401) 595-4076
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 |
|---|---|---|---|
| 28877 | CA | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Complete Spine and Wellness Group, Inc | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Rehabilitation Chiropractor
- Costa Mesa, CA
- NPI 1003038399
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1235520000000",
"number": "1639319924",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4704 SEASHORE DR",
"address_2": "APT B",
"city": "NEWPORT BEACH",
"state": "CA",
"postal_code": "926632524",
"telephone_number": "401-595-4076"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1640 NEWPORT BLVD",
"address_2": "SUITE 220",
"city": "COSTA MESA",
"state": "CA",
"postal_code": "926273786",
"telephone_number": "949-650-4362"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "JASON",
"middle_name": "WILLIAM",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-02-25",
"last_updated": "2009-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "28877",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Costa Mesa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.