Active NPI
Jeremy David Nelson, MPT
- Physical Therapist
- San Diego, CA
National Provider Identifier
1841436656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 23510
- Practice address
- 13330 Via Bellarado
Unit 1
San Diego, CA 92129-5158 - Phone
- (619) 997-5552
- NPI assigned
- Dec 29, 2008
- 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 | 23510 | CA | Primary |
Addresses
Primary practice location
13330 Via Bellarado
Unit 1
San Diego, CA 92129-5158
Mailing address
13330 Via Bellarado
Unit 1
San Diego, CA 92129-5158
Phone (619) 997-5552
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 23510 | Other | CA | CALIFORNIA STATE LICENSE |
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 |
|---|---|---|---|
| 23510 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stithem & Johnson Physical Therapy, Inc. | Physical Therapist | Past | Accepting new patients |
| Stithem & Johnson Physical Therapy Inc. | Physical Therapist | Past | Accepting new patients |
| Neck & Back Medical Center Inc. | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 3
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.
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- NPI 1407806771
-
- Physical Therapy Clinic/Center
- Santa Rosa, CA
- NPI 1831386838
Physical Therapist
-
- Physical Therapy Clinic/Center
- Santa Rosa, CA
- NPI 1982689675
Physical Therapist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1230508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1402272000000",
"number": "1841436656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13330 VIA BELLARADO",
"address_2": "UNIT 1",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921295158",
"telephone_number": "619-997-5552"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13330 VIA BELLARADO",
"address_2": "UNIT 1",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921295158",
"telephone_number": "619-997-5552"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "JEREMY",
"middle_name": "DAVID",
"name_prefix": "Mr.",
"credential": "MPT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-12-29",
"last_updated": "2014-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "23510",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CALIFORNIA STATE LICENSE",
"identifier": "23510",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.