Active NPI
Gregory Booth, P.T.
- Physical Therapist
- Fremont, CA
National Provider Identifier
1760417448
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 17617
- Practice address
- 38690 Stivers St
Fremont, CA 94536-5336 - Phone
- (510) 794-8484
- Fax
- (510) 792-5213
- NPI assigned
- Jul 11, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 17617 | CA | Primary |
Addresses
Primary practice location
38690 Stivers St
Fremont, CA 94536-5336
Mailing address
2296 Country Dr
Fremont, CA 94536-5315
Phone (510) 797-9299
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0PT176170 | Other | CA | BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080715000850 | CA | Practitioner - Physical Therapist in Private Practice | 6406929033 | Practice locations: Truckee, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1991
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
10775 Pioneer TRL
Truckee, CA 96161-0233
Phone (530) 448-5055
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152576000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1760417448",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2296 COUNTRY DR",
"city": "FREMONT",
"state": "CA",
"postal_code": "945365315",
"telephone_number": "510-797-9299",
"fax_number": "510-608-3670"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "38690 STIVERS ST",
"city": "FREMONT",
"state": "CA",
"postal_code": "945365336",
"telephone_number": "510-794-8484",
"fax_number": "510-792-5213"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOOTH",
"first_name": "GREGORY",
"credential": "P.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "17617",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "0PT176170",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fremont, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.