Jenna L Thacker, OT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

31005322A Issued in IN

Practice address

225 Crosslake Dr
Evansville, IN 47715-8198

Phone

(812) 471-6677

Fax

(812) 474-2296

NPI assigned

Jul 16, 2012

Last updated

Jul 8, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Jenna L Betulius Former name

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Prorehab IncGroup PAC ID 1254317217, 81 clinicians

Tri-State Orthopaedic Surgeons IncGroup PAC ID 6800781949, 60 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

66.6 of 100Reported as group

Quality

60.71

Promoting interoperability

33

Improvement activities

40

Cost

83.78

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

• Prorehab Inc

  • Physical Therapist
  • Evansville, IN
  • NPI 1770565509

  Occupational Therapist

  Medicare reassignment Care Compare group NPD
• Tri-State Orthopaedic Surgeons, Inc.

  • Orthopaedic Surgery Physician
  • Evansville, IN
  • NPI 1073501003
  Medicare reassignment Care Compare group NPD
• Orthopaedics-Indianapolis, Inc

  • Orthopaedic Surgery Physician
  • Indianapolis, IN
  • NPI 1336252451

  Occupational Therapist

  Medicare reassignment NPD
• Orthopaedics-Indianapolis, Inc

  dba Orthoindy - St. Vincent Indianapolis

  • Orthopaedic Surgery Physician
  • Indianapolis, IN
  • NPI 1134431125
  NPD
• Orthopaedics-Indianapolis, Inc

  dba Orthoindy

  • Orthopaedic Surgery Physician
  • Terre Haute, IN
  • NPI 1285433953
  NPD
• Prorehab Inc

  • Durable Medical Equipment & Medical Supplies
  • Vincennes, IN
  • NPI 1841014933

  Occupational Therapist

  NPD
• Tri-State Orthopaedic Surgeons, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Vincennes, IN
  • NPI 1699414961
  NPD
• Tri-State Orthopaedic Surgeons, Inc.

  • Physical Therapist
  • Evansville, IN
  • NPI 1730357237

  Occupational Therapist

  NPD

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

{
    "created_epoch": "1342396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404777600000",
    "number": "1689929614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7300 E INDIANA ST",
            "address_2": "SUITE 102",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477152794",
            "telephone_number": "812-476-0409",
            "fax_number": "812-476-1016"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 CROSSLAKE DR",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477158198",
            "telephone_number": "812-471-6677",
            "fax_number": "812-474-2296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THACKER",
        "first_name": "JENNA",
        "middle_name": "L",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-16",
        "last_updated": "2014-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IN",
            "license": "31005322A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201107090",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000782655",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "000000782963",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD BLUE CROSS",
            "identifier": "000000783241",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNA",
            "last_name": "BETULIUS",
            "middle_name": "L",
            "credential": "OT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Terre Haute Senior Care, LLC (Home Instead Senior Care)
• Jill Terrill, LPN
• Ciara Terry
• Raymond C Tervo, MD
• Mark Tesanovich
• Terry Brandon Thacker, M.D.
• Killol J Thakore, MD
• Patricia W Tharp, M.D.
• Hailey Thayer
• The Chesnut Group of Indiana

• Occupational Therapist in Evansville, IN
• Providers in Evansville, IN by specialty
• Occupational Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2014; 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.