Jake Ryan Bostick, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT028863 Issued in PA

Practice address

3075 Enterprise Dr Ste 200
State College, PA 16801-3241

Phone

(814) 308-8482

NPI assigned

Aug 18, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Atlas Therapy Inc.Group PAC ID 7113100181, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Atlas Therapy Inc.

  • Physical Therapist
  • State College, PA
  • NPI 1962715359
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1597708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1597708800000",
    "number": "1669084075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3075 ENTERPRISE DR STE 200",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168013241",
            "telephone_number": "814-308-8482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3075 ENTERPRISE DR STE 200",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "168013241",
            "telephone_number": "814-308-8482"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOSTICK",
        "first_name": "JAKE",
        "middle_name": "RYAN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-18",
        "last_updated": "2020-08-18",
        "certification_date": "2020-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT028863",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "WebPT",
            "affiliation": "N",
            "endpointDescription": "EMR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "3075 Enterprise Dr Ste 200",
            "city": "State College",
            "state": "PA",
            "country_code": "US",
            "postal_code": "168013241",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jennifer Bonanni, PHARMD, BCPS, BCACP
• Casey Lee Bonsell, PHARMD
• Roberta Jean Boob, PTA
• Sarah E Bork, MD
• Philip J. Bosha, M.D.
• John I Boswell III, M.D.
• Joshua Randel Botteicher
• Phillip Donald Bottenfield
• Kasandra Ann Botti, D.O.
• Ashley Marie Bowser, PA-C

• Physical Therapist in State College, PA
• Providers in State College, PA by specialty
• Physical Therapist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 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.