Active NPI
Jessica Lynn Sargalis, MPT
- Pediatric Physical Therapist
- Broadalbin, NY
National Provider Identifier
1689944670
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 022845-1
- Practice address
- 100 Bridge St
Broadalbin, NY 12025-2193 - Phone
- (518) 954-2645
- Fax
- (518) 954-2659
- NPI assigned
- Jan 6, 2012
- Last updated
- Jan 6, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 022845-1 | NY | Primary |
Addresses
Primary practice location
100 Bridge St
Broadalbin, NY 12025-2193
Mailing address
20 Pine St
Broadalbin, NY 12025-3128
Phone (518) 954-2500
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538212907 | Other | NY | BROADALBIN-PERTH CSD NPI NUMBER |
| 251300000X | Other | BROADALBIN-PERTH CSD TAXONOMY NUMBER | |
| 01414337 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 022845-1 | NY | MD | Pediatric Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Broadalbin-Perth Central School District | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Local Education Agency (LEA)
- Broadalbin, NY
- NPI 1538212907
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1325808000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325808000000",
"number": "1689944670",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 PINE ST",
"city": "BROADALBIN",
"state": "NY",
"postal_code": "120253128",
"telephone_number": "518-954-2500",
"fax_number": "518-954-2509"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 BRIDGE ST",
"city": "BROADALBIN",
"state": "NY",
"postal_code": "120252193",
"telephone_number": "518-954-2645",
"fax_number": "518-954-2659"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SARGALIS",
"first_name": "JESSICA",
"middle_name": "LYNN",
"name_prefix": "Mrs.",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-01-06",
"last_updated": "2012-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "NY",
"license": "022845-1",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BROADALBIN-PERTH CSD NPI NUMBER",
"identifier": "1538212907",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BROADALBIN-PERTH CSD TAXONOMY NUMBER",
"identifier": "251300000X",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01414337",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Broadalbin, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.