Kristina A Jaeckel, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

13405 Issued in MA

Practice address

120 Gold Star Blvd
Worcester, MA 01606-2825

Phone

(508) 453-4590

Fax

(508) 459-5900

NPI assigned

Jul 24, 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 MA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Greendale Physical Therapy LLCGroup PAC ID 9133013691, 36 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.

• Greendale Physical Therapy, LLC

  • Physical Therapist
  • Shrewsbury, MA
  • NPI 1053316182
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1248393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439337600000",
    "number": "1821228842",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "280 BOSTON TPKE",
            "city": "SHREWSBURY",
            "state": "MA",
            "postal_code": "015452640",
            "telephone_number": "508-853-4590",
            "fax_number": "949-756-4811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 GOLD STAR BLVD",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016062825",
            "telephone_number": "508-453-4590",
            "fax_number": "508-459-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAECKEL",
        "first_name": "KRISTINA",
        "middle_name": "A",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-24",
        "last_updated": "2015-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "13405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elie Jacques
• Elise A Jacques, MD
• Michele Jacquin
• Neville M Jadeja, MD
• Nupur Chandrasen Jadhav, MD
• Kate Jaegle, MSN, APRN, AGNP-C
• Kanwal Jaffari
• Carol A Jaffarian, NP
• Wasfa Jaffri
• Deepa Jagadeesh, M.D.

• Physical Therapist in Worcester, MA
• Providers in Worcester, MA by specialty
• Physical Therapist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2015; 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.