Individual provider Active NPI

Jennifer L Gorman, PT

  • Physical Therapist
  • Worcester, MA
National Provider Identifier
1770800765
Registry record updated Apr 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
18681 Issued in MA
Practice address
111 Elm St
Suite 103
Worcester, MA 01609-1967
Phone
(508) 799-6538
Fax
(508) 799-5535
NPI assigned
Apr 29, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2010

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 18681 MA Primary

Addresses

Primary practice location

111 Elm St
Suite 103
Worcester, MA 01609-1967

Mailing address

111 Elm St
Suite 103
Worcester, MA 01609-1967
Phone (508) 799-6538

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100727000297 MA Practitioner - Physical Therapist in Private Practice 6901939040 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dynamic Physical Therapy Services LLCGroup PAC ID 1254300932, 2 clinicians

Practice addresses (Care Compare)

111 Elm St
Suite 103
Worcester, MA 01609-1921
Phone (508) 799-6538

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18681MAMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Dynamic Physical Therapy Services LLC Physical Therapist CurrentSince Apr 14, 2010 Accepting new patients
Bay State Physical Therapy of Randolph Inc Physical Therapist CurrentSince Aug 1, 2020 Accepting new patients
Bay State Physical Therapy of Randolph Inc Physical Therapist CurrentSince Aug 1, 2020 Accepting new patients
Elm Park Physical Therapy LLC Physical Therapist PastSince Apr 14, 2010 Accepting new patients

Locations

703 Granite St
Ste 3
Braintree, MA 02184

1 Pearl St
Ste 1700
Brockton, MA 02301
Phone (508) 427-0525

1037 Main St
Leicester, MA 01524
Phone (508) 892-1335

1343 Providence Hwy
Norwood, MA 02062
Phone (781) 702-1339

1054 County St
Somerset, MA 02726
Phone (508) 674-3340

23 Ware St
West Brookfield, MA 01585
Phone (508) 867-0180

111 Elm St
Ste 103
Worcester, MA 01609
Phone (508) 799-6538

Organizations & group practices 4

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": "1272499200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272499200000",
    "number": "1770800765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 ELM ST",
            "address_2": "SUITE 103",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016091967",
            "telephone_number": "508-799-6538",
            "fax_number": "508-799-5535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 ELM ST",
            "address_2": "SUITE 103",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016091967",
            "telephone_number": "508-799-6538",
            "fax_number": "508-799-5535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORMAN",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-29",
        "last_updated": "2010-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "18681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2010; 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.