Individual provider Active NPI

Jiaxu Huang

  • Physical Therapist
  • Lexington, MA
National Provider Identifier
1821821182
Registry record updated Aug 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
57 Bedford St Ste 202
Lexington, MA 02420-4550
Phone
(781) 541-5111
Fax
(781) 541-5115
NPI assigned
Aug 22, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2024

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 MA Primary

Addresses

Primary practice location

57 Bedford St Ste 202
Lexington, MA 02420-4550

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240911002085 MA Practitioner - Physical Therapist in Private Practice 9335689835 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Performance Rehabilitation of Western New England LLCGroup PAC ID 7911979950, 201 clinicians

Practice addresses (Care Compare)

57 Bedford St
Suite 202
Lexington, MA 02420-4550
Phone (781) 541-5111

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Performance Rehabilitation of Western New England LLC Physical Therapist CurrentSince Aug 12, 2024 Accepting new patients
Performance Rehabilitation of Western New England LLC Physical Therapist CurrentSince Aug 12, 2024 Accepting new patients
Performance Rehabilitation of Western New England LLC Physical Therapist Current Accepting new patients
Carl Gustafson LLC Physical Therapist Past Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

33377 Collection Ctr Dr
Chicago, IL 60693
Phone (617) 284-9418

101 University Dr
Ste A6
Amherst, MA 01002
Phone (413) 336-5703

57 Bedford St
Ste 202
Lexington, MA 02420
Phone (781) 541-5111

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1724284800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724284800000",
    "number": "1821821182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57 BEDFORD ST STE 202",
            "city": "LEXINGTON",
            "state": "MA",
            "postal_code": "024204550",
            "telephone_number": "781-541-5111",
            "fax_number": "781-541-5115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUANG",
        "first_name": "JIAXU",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-22",
        "last_updated": "2024-08-22",
        "certification_date": "2024-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2024; 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.