Active NPI
Jerald Douglas Bozeman Jr., PT
- Physical Therapist
- Wichita, KS
National Provider Identifier
1821138827
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11-032675
- Practice address
- 750 N Socora
Wichita, KS 67212 - Phone
- (316) 462-2273
- Fax
- (316) 462-2276
- NPI assigned
- Feb 7, 2007
- 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 | 11-032675 | KS | Primary |
Addresses
Primary practice location
750 N Socora
Wichita, KS 67212
Mailing address
6405 W Clear Meadow St
Wichita, KS 67205-2413
Phone (316) 201-4631
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11-032675 | KS | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ascension Via Christi Rehabilitation Hospital, Inc. | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Wichita, KS
- NPI 1477504645
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1821138827",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6405 W CLEAR MEADOW ST",
"city": "WICHITA",
"state": "KS",
"postal_code": "672052413",
"telephone_number": "316-201-4631"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "750 N SOCORA",
"city": "WICHITA",
"state": "KS",
"postal_code": "67212",
"telephone_number": "316-462-2273",
"fax_number": "316-462-2276"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOZEMAN",
"first_name": "JERALD",
"middle_name": "DOUGLAS",
"name_prefix": "Mr.",
"name_suffix": "Jr.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "KS",
"license": "11-032675",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wichita, KS
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.