Jac Randall Doran

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

R1148 Issued in MO

Practice address

1948 E Chesapeake Dr
Ozark, MO 65721-7815

Phone

(417) 551-3210

Fax

(888) 527-0428

NPI assigned

Oct 7, 2009

Sex

Male

Sole proprietor

Yes

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 MO

Enrollment records 1

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.

• Willard Physical Therapy Center LLC

  • Physical Therapy Clinic/Center
  • Willard, MO
  • NPI 1528737780

  MO, Physical Therapist

  Medicare reassignment NPD
• Ozarks Physical Therapy Associates Inc.

  • Rehabilitation Clinic/Center
  • Springfield, MO
  • NPI 1104906338
  NPD (past)
• S and B Health Services, Incorporated

  • Rehabilitation Clinic/Center
  • Ozark, MO
  • NPI 1376773309
  NPD (past)

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

{
    "created_epoch": "1254873600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1254873600000",
    "number": "1821323957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6104 N 27TH ST",
            "city": "OZARK",
            "state": "MO",
            "postal_code": "657215857",
            "telephone_number": "417-838-1701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1948 E CHESAPEAKE DR",
            "city": "OZARK",
            "state": "MO",
            "postal_code": "657217815",
            "telephone_number": "417-551-3210",
            "fax_number": "888-527-0428"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DORAN",
        "first_name": "JAC",
        "middle_name": "RANDALL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-10-07",
        "last_updated": "2009-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "R1148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacy M Depriest, CCC-SLP
• Lindsey Jane Dillion, MS, LPC, NCC
• Holly Lee Divin-Deckard, PLPC
• Susan Rebecca Dodds Kurth, LMT
• Erin Michelle Dominguez, PHARMD
• Dr M.a. Vega Chiropractic Physician P.C.
• Kristine Drane, PT, DPT
• Collin Dean Allen Drummond, DPT
• Susan E Duke, DO
• Elizabeth Duley

• All providers in Ozark, MO
• Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.