Individual provider Active NPI

Jason Anthony Palmer, D.C.

  • Chiropractor
  • Redlands, CA
National Provider Identifier
1740418771
Registry record updated Jan 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC 30254 Issued in CA
Practice address
1235 Indiana CT
Suite 105
Redlands, CA 92374-4540
Phone
(909) 793-4515
NPI assigned
Jun 29, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 23, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X DC 30254 CA Primary

Addresses

Primary practice location

1235 Indiana CT
Suite 105
Redlands, CA 92374-4540

Mailing address

1235 Indiana CT
Suite 105
Redlands, CA 92374-4540
Phone (909) 793-4515

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220601003241 FL Practitioner - Chiropractic 3274758909 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2005
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1092 S Ponce de Leon Blvd
Suite K
St Augustine, FL 32084-6018
Phone (904) 460-2923

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DC 30254CAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Chiro & Laser St. Augustine, PLLC CurrentSince Apr 13, 2022 Accepting new patients
Chiro & Laser Pain Relief Center of St Augustine LLC Chiropractor PastSince Jun 1, 2019 Accepting new patients
Bugg Chiropractic Inc. Chiropractor PastSince Mar 13, 2022 Accepting new patients

Locations

1092 S Ponce de Leon Blvd
#K
Saint Augustine, FL 32084
Phone (904) 460-2923

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1246233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390435200000",
    "number": "1740418771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 INDIANA CT",
            "address_2": "SUITE 105",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923744540",
            "telephone_number": "909-793-4515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 INDIANA CT",
            "address_2": "SUITE 105",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923744540",
            "telephone_number": "909-793-4515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALMER",
        "first_name": "JASON",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-06-29",
        "last_updated": "2014-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC 30254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redlands, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 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.