Individual provider Active NPI

Jeffrey David Kuppersmith, DC

  • Chiropractor
  • Gilbert, AZ
National Provider Identifier
1699754838
Registry record updated Dec 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
7280 Issued in AZ
Practice address
610 N Gilbert Rd
Suite 309
Gilbert, AZ 85234-4502
Phone
(480) 926-1111
Fax
(480) 926-2958
NPI assigned
Jan 16, 2006
Last updated
Dec 21, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 21, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 7280 AZ Primary

Addresses

Primary practice location

610 N Gilbert Rd
Suite 309
Gilbert, AZ 85234-4502

Mailing address

610 N Gilbert Rd
Suite 309
Gilbert, AZ 85234-4502
Phone (480) 926-1111

Other identifiers 1

IdentifierTypeStateIssuer
619494MedicaidAZ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050323000523 AZ Practitioner - Chiropractic 0244285302 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chiropractic Health Innovations PLCGroup PAC ID 7012925332, 4 clinicians

Practice addresses (Care Compare)

7254 E Southern Ave
Suite 113
Mesa, AZ 85209-2787
Phone (480) 807-1324

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Az Family Chiropractic LLC Chiropractor CurrentSince Dec 1, 2020 Accepting new patients
Alpha Medical Group LLC Chiropractor CurrentSince Dec 1, 2020 Accepting new patients
Chiropractic Health Innovations, PLC Chiropractor CurrentSince Oct 3, 2022 Accepting new patients
Medwell LLC Past Accepting new patients
Next Level Facility LLC PastSince Nov 12, 2023 Accepting new patients
Gilbert PT, LLC Chiropractor Past Accepting new patients

Locations

3126 S Higley Rd
Ste 102
Gilbert, AZ 85295
Phone (480) 988-2974

7254 E Southern Ave
Ste 113
Mesa, AZ 85209
Phone (480) 588-2233

Organizations & group practices 6

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": "1137369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324425600000",
    "number": "1699754838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 N GILBERT RD",
            "address_2": "SUITE 309",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852344502",
            "telephone_number": "480-926-1111",
            "fax_number": "480-926-2958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 N GILBERT RD",
            "address_2": "SUITE 309",
            "city": "GILBERT",
            "state": "AZ",
            "postal_code": "852344502",
            "telephone_number": "480-926-1111",
            "fax_number": "480-926-2958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUPPERSMITH",
        "first_name": "JEFFREY",
        "middle_name": "DAVID",
        "credential": "DC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-16",
        "last_updated": "2011-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "7280",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "619494",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gilbert, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2011; 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.