Individual provider Active NPI

Ann Marie Jaquess, PT

  • Physical Therapist
  • Las Cruces, NM
National Provider Identifier
1770860579
Registry record updated Nov 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
1091 Issued in NM
Practice address
2404 S Locust St Ste 5
Las Cruces, NM 88001-5789
Phone
(575) 521-4188
Fax
(575) 521-3668
NPI assigned
Nov 8, 2011
Last updated
Nov 8, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2011

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 1091 NM Primary

Addresses

Primary practice location

2404 S Locust St Ste 5
Las Cruces, NM 88001-5789

Mailing address

2404 S Locust St Ste 5
Las Cruces, NM 88001-5789

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111128000663 NM Practitioner - Physical Therapist in Private Practice 4587838776 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southwest Sport and Spine Center IncGroup PAC ID 5496656563, 21 clinicians

Practice addresses (Care Compare)

1181 Mall Dr
Suite C
Las Cruces, NM 88011-8105
Phone (575) 522-0766

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1091NMMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Sport and Spine Center Inc Physical Therapist CurrentSince Oct 17, 2011 Accepting new patients
Real View Diagnostics LLC Physical Therapist PastSince Oct 17, 2011 Accepting new patients

Locations

1181 Mall Dr
Las Cruces, NM 88011
Phone (505) 521-1111

1181 Mall Dr
Ste C
Las Cruces, NM 88011
Phone (575) 522-0766

2404 S Locust St
Ste 5
Las Cruces, NM 88001
Phone (505) 521-4188

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, 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": "1320710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320710400000",
    "number": "1770860579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2404 S LOCUST ST STE 5",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880015789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2404 S LOCUST ST STE 5",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880015789",
            "telephone_number": "575-521-4188",
            "fax_number": "575-521-3668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAQUESS",
        "first_name": "ANN",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-08",
        "last_updated": "2011-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NM",
            "license": "1091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Cruces, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2011; 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.