Jacob Carlson

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

12528 Issued in SC

Practice address

6600 Van Aalst Blvd
Fort Benning, GA 31905-2102

Phone

(762) 408-2273

NPI assigned

Aug 18, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA, AZ2 enrollments

Enrollment records 2

Specialty

Physical Therapist in Private Practice

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Foothills Sports Medicine and Rehabilitation LLCGroup PAC ID 2668457979, 172 clinicians

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Foothills Sports Medicine & Rehabilitation, LLC

  • Physical Therapist
  • Phoenix, AZ
  • NPI 1558318170
  Medicare reassignment Care Compare group NPD
• Au Medical Center, Inc

  • General Acute Care Hospital
  • Augusta, GA
  • NPI 1437135902
  Medicare reassignment NPD
• Au Medical Center, Inc.

  • Community/Retail Pharmacy
  • Augusta, GA
  • NPI 1487901476
  NPD
• Foothills Sports Medicine & Rehabilitation, LLC

  • Durable Medical Equipment & Medical Supplies
  • Tucson, AZ
  • NPI 1073224267
  NPD
• Phoebe Physician Group, Inc

  • Clinic/Center
  • Albany, GA
  • NPI 1487899464
  NPD (past)

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

{
    "created_epoch": "1692316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779321600000",
    "number": "1710761069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 VAN AALST BLVD",
            "city": "FORT BENNING",
            "state": "GA",
            "postal_code": "319052102",
            "telephone_number": "762-408-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 VAN AALST BLVD",
            "city": "FORT BENNING",
            "state": "GA",
            "postal_code": "319052102",
            "telephone_number": "762-408-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARLSON",
        "first_name": "JACOB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-18",
        "last_updated": "2026-05-21",
        "certification_date": "2026-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "12528",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Avril Campbell-Sims, M.D.
• Kala Campbell
• Dean Canestrini II, MD
• Edna Canino, LCSW
• Dean Patrick Cardi, D.O.
• Nicole Lynn Case, DNP, FNP-C
• Vincent Edwin Casiano, M.D.
• David Alan Cass, MD
• Caitlyn Summer Causey, PA
• Mario Caycedo, MD

• Physical Therapist in Fort Benning, GA
• Providers in Fort Benning, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2026; 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.