Individual provider Active NPI

Jennifer Gould

  • Physical Therapist
  • Waltham, MA
National Provider Identifier
1710301619
Registry record updated Feb 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
840 Winter St
Attn: Pro Sports Therapy
Waltham, MA 02451-1433
Phone
(781) 487-9944
Fax
(781) 487-9966
NPI assigned
Feb 12, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X MA Primary

Addresses

Primary practice location

840 Winter St
Attn: Pro Sports Therapy
Waltham, MA 02451-1433

Mailing address

840 Winter St
Attn: Pro Sports Therapy
Waltham, MA 02451-1433
Phone (781) 487-9944

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140605000058 MA Practitioner - Physical Therapist in Private Practice 6507080934 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pro Sports Therapy IncGroup PAC ID 6901708544, 13 clinicians

Practice addresses (Care Compare)

334 Littleton Rd
Suite 2
Westford, MA 01886-4124
Phone (978) 392-0483

840 Winter St
Waltham, MA 02451-1433

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Pro Sports Therapy, Inc. Physical Therapist CurrentSince Feb 17, 2014 Accepting new patients

Locations

840 Winter St
Waltham, MA 02451
Phone (781) 487-9944

71 Border Rd
Waltham, MA 02451
Phone (781) 487-9944

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/1148/brand/1/csg/1/fhir/r4

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1392163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392163200000",
    "number": "1710301619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "840 WINTER ST",
            "address_2": "ATTN: PRO SPORTS THERAPY",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024511433",
            "telephone_number": "781-487-9944",
            "fax_number": "781-487-9966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 WINTER ST",
            "address_2": "ATTN: PRO SPORTS THERAPY",
            "city": "WALTHAM",
            "state": "MA",
            "postal_code": "024511433",
            "telephone_number": "781-487-9944",
            "fax_number": "781-487-9966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOULD",
        "first_name": "JENNIFER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-12",
        "last_updated": "2014-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waltham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 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.