Individual provider Active NPI

Jenna R Elliott, PT

  • Physical Therapist
  • West Columbia, SC
National Provider Identifier
1740393933
Registry record updated Sep 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
3014 Issued in SC
Practice address
1900 Sunset Blvd
West Columbia, SC 29169-5932
Phone
(803) 926-7204
NPI assigned
Aug 15, 2006
Last updated
Sep 27, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2017

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 3014 SC Primary

Addresses

Primary practice location

1900 Sunset Blvd
West Columbia, SC 29169-5932

Mailing address

1311 Augusta Rd
West Columbia, SC 29169-6320
Phone (803) 926-7204

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060919000314 SC Practitioner - Physical Therapist in Private Practice 5395740757 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Medical University of South Carolina College of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Sigurd Center for Ortho and Neuro RehabGroup PAC ID 0547277063, 11 clinicians

Practice addresses (Care Compare)

1311 Augusta Rd
West Columbia, SC 29169-6320
Phone (803) 926-7204

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3014SCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
The Sigurd Center for Ortho & Neuro Rehab Physical Therapist CurrentSince Aug 11, 2006 Accepting new patients
Medsource Inc. PastSince Aug 11, 2006 Accepting new patients
Key Changes Therapy Services, Inc Physical Therapist PastSince Feb 7, 2018 Accepting new patients

Locations

1311 Augusta Rd
West Columbia, SC 29169
Phone (803) 926-2919

1900 Sunset Blvd
West Columbia, SC 29169
Phone (803) 250-6833

Organizations & group practices 3

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": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1506470400000",
    "number": "1740393933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 AUGUSTA RD",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291696320",
            "telephone_number": "803-926-7204",
            "fax_number": "803-926-7206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 SUNSET BLVD",
            "city": "WEST COLUMBIA",
            "state": "SC",
            "postal_code": "291695932",
            "telephone_number": "803-926-7204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "JENNA",
        "middle_name": "R",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-15",
        "last_updated": "2017-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "3014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in West Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2017; 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.