Deogenes De Asas Enteria Jr., PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT018712 Issued in PA

Practice address

3201 W. Commercial Blvd.
Suite 116
Fort Lauderdaxle, FL 33309-3440

Phone

(954) 332-4445

Fax

(954) 332-4340

NPI assigned

Nov 6, 2007

Last updated

Nov 6, 2007By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cortlyn Therapy PCGroup PAC ID 8729495684, 141 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cortlyn Therapy, PC

  dba Symbria Outpatient Services

  • Physical Therapist
  • Cincinnati, OH
  • NPI 1235725730

  PA

  Medicare reassignment Care Compare group NPD
• Medpro

  • Physical Therapist
  • Fort Lauderdale, FL
  • NPI 1033353339
  NPD (past)

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

{
    "created_epoch": "1194307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194307200000",
    "number": "1669652863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3290 NORTH RIDGE ROAD EXECUTIVE CENTER II",
            "address_2": "SUITE 290",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210433655",
            "telephone_number": "410-750-9006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 W. COMMERCIAL BLVD.",
            "address_2": "SUITE 116",
            "city": "FORT LAUDERDAXLE",
            "state": "FL",
            "postal_code": "333093440",
            "telephone_number": "954-332-4445",
            "fax_number": "954-332-4340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ENTERIA",
        "first_name": "DEOGENES",
        "middle_name": "DE ASAS",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-06",
        "last_updated": "2007-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "PA",
            "license": "PT018712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 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.