NPIMap

Individual provider Active NPI

Baxter Oliver Deal III, MPT, LOTR

  • Occupational Therapist
  • Jennings, LA
National Provider Identifier
1679689566
Registry record updated Jul 25, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
OTT.Z12349 Issued in LA
Practice address
2002 Johnson St
Suite 100
Jennings, LA 70546-3646
Phone
(337) 824-4547
Fax
(337) 824-4548
NPI assigned
Aug 22, 2006
Last updated
Jul 25, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 05284 LA
Occupational Therapist 225X00000X OTT.Z12349 LA Primary

Addresses

Primary practice location

2002 Johnson St
Suite 100
Jennings, LA 70546-3646

Mailing address

2002 Johnson St
Ste 100
Jennings, LA 70546-3640
Phone (337) 824-4547

Other identifiers 2

IdentifierTypeStateIssuer
1467898MedicaidLA
1178543MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100826000707 LA Practitioner - Occupational Therapist in Private Practice 6103940242 Reassigns benefits to 1 organization
I20110325000364 LA Practitioner - Physical Therapist in Private Practice 6103940242 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Therapy Center of Jefferson Davis Parish, Inc Physical Therapist CurrentSince Dec 30, 2002 Accepting new patients
Lemoine Therapy Services of Cenla Inc Physical Therapist PastSince Dec 30, 2002 Accepting new patients

Locations

2002 Johnson St
Ste 100
Jennings, LA 70546
Phone (337) 824-8287

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": "1156204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469404800000",
    "number": "1679689566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2002 JOHNSON ST",
            "address_2": "STE 100",
            "city": "JENNINGS",
            "state": "LA",
            "postal_code": "705463640",
            "telephone_number": "337-824-4547",
            "fax_number": "337-824-4548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 JOHNSON ST",
            "address_2": "SUITE 100",
            "city": "JENNINGS",
            "state": "LA",
            "postal_code": "705463646",
            "telephone_number": "337-824-4547",
            "fax_number": "337-824-4548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEAL",
        "first_name": "BAXTER",
        "middle_name": "OLIVER",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "MPT, LOTR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-22",
        "last_updated": "2016-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "LA",
            "license": "05284",
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "LA",
            "license": "OTT.Z12349",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1467898",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1178543",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jennings, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.