Jerrad Hada, PT
Individual provider Active NPI Physical Therapist · Alva, OK
NPI 1679922462 · NPPES record last updated Jul 16, 2019
Key facts
- NPI
- 1679922462
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- PT5162 (OK)
- Practice address
- 520 Flynn St
Alva, OK 73717-2240 - Phone
- (580) 327-3331
- Fax
- (580) 327-3314
- NPI assigned
- Jun 13, 2016
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- University of Oklahoma College of Medicine, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
520 Flynn St
Alva, OK 73717-2240
Phone (580) 327-3331
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160825000173 | OK | Practitioner - Physical Therapist in Private Practice | 2466747795 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5162 | OK | MD | Sports Medicine (Physical Medicine & Rehabilitation) Physician |
| PT5162 | OK | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Human Performance Center 3 PLLC | Sports Medicine | Current |
Accepting new patients |
Locations
520 Flynn St
Alva, OK 73717
Phone (580) 327-3331
919 Oklahoma Blvd
Alva, OK 73717
Phone (580) 327-3331
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Physical Medicine & Rehabilitation) Physician | 2081S0010X | 5162 | OK | |
| Physical Therapist | 225100000X | PT5162 | OK | Yes |
Addresses
Primary practice location
520 Flynn St
Alva, OK 73717-2240
Mailing address
520 Flynn St
Alva, OK 73717-2240
Phone (580) 327-3331
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200693970A | Medicaid | OK |
Other providers in Alva, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 16, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.