Jessica L Super, PT, DPT, CSCS

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT35434 Issued in CA

Practice address

44651 Village CT Ste 120
Palm Desert, CA 92260-3823

Phone

(760) 501-6655

Fax

(760) 262-3773

NPI assigned

Mar 3, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dynamic Physical Therapy and Sports Performance IncGroup PAC ID 5092004051, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Dynamic Physical Therapy and Sports Performance, Inc

  • Physical Therapy Clinic/Center
  • Palm Desert, CA
  • NPI 1770958670

  Physical Therapist

  Medicare reassignment Care Compare group NPD
• Lyle J. Reber, MD, Inc

  • Sports Medicine (Orthopaedic Surgery) Physician
  • La Quinta, CA
  • NPI 1891124954
  NPD (past)

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

{
    "created_epoch": "1236038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456876800000",
    "number": "1801036819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "44651 VILLAGE CT STE 120",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922603823",
            "telephone_number": "760-501-6655",
            "fax_number": "760-262-3773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "44651 VILLAGE CT STE 120",
            "city": "PALM DESERT",
            "state": "CA",
            "postal_code": "922603823",
            "telephone_number": "760-501-6655",
            "fax_number": "760-262-3773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUPER",
        "first_name": "JESSICA",
        "middle_name": "L",
        "credential": "PT, DPT, CSCS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-03-03",
        "last_updated": "2016-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT35434",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeronimo Subayar
• Gregory Suchin, DPT
• Sula Dialysis, LLC
• Veronica Sumi
• Suncrest Healthcare
• Susanne Armstrong Investments LLC
• Megan Kellie Suwara, FNP
• Suzanne M. Quardt MD
• Gabrielle Siena Svoboda
• Ashley Swain

• Physical Therapist in Palm Desert, CA
• Providers in Palm Desert, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2016; 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.