Active NPI
Jeramiah Fortune, DPT
- Physical Therapist
- Riverton, UT
National Provider Identifier
1770729949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4985050-2401
- Practice address
- 13747 Redwood Rd
Riverton, UT 84065 - Phone
- (801) 938-9806
- Fax
- (801) 417-9399
- NPI assigned
- Dec 18, 2008
- Sex
- Male
- Sole proprietor
- No
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 | 4985050-2401 | UT | Primary |
Addresses
Primary practice location
13747 Redwood Rd
Riverton, UT 84065
Mailing address
P.O. Box 711185
Salt Lake City, UT 84121
Phone (801) 942-3311
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in UT
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101213000848 | UT | Practitioner - Physical Therapist in Private Practice | 0547457830 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2192 W 100
Hurricane, UT 84737-1329
Phone (435) 767-0747
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Independence Rehab | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Physical Therapist
- Salt Lake City, UT
- NPI 1407982630
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1229558400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358121600000",
"number": "1770729949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 711185",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "84121",
"telephone_number": "801-942-3311",
"fax_number": "801-942-5955"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13747 REDWOOD RD",
"city": "RIVERTON",
"state": "UT",
"postal_code": "84065",
"telephone_number": "801-938-9806",
"fax_number": "801-417-9399"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORTUNE",
"first_name": "JERAMIAH",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-12-18",
"last_updated": "2013-01-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "UT",
"license": "4985050-2401",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverton, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2013; 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.