Jackie Earlene Primos, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MT22308074 Issued in IN

Practice address

7895 Broadway Ste D
Merrillville, IN 46410-5529

Phone

(219) 440-6612

NPI assigned

Jan 25, 2024

Sex

Female

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Zen Wellness & Retreats, Inc

  • Massage Therapist
  • Merrillville, IN
  • NPI 1285496307
  NPD Authorized official

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

{
    "created_epoch": "1706140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706140800000",
    "number": "1861254815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1952 W 2ND AVE",
            "city": "GARY",
            "state": "IN",
            "postal_code": "464041108",
            "telephone_number": "219-794-4626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7895 BROADWAY STE D",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464105529",
            "telephone_number": "219-440-6612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIMOS",
        "first_name": "JACKIE",
        "middle_name": "EARLENE",
        "credential": "LMT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-01-25",
        "last_updated": "2024-01-25",
        "certification_date": "2024-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "IN",
            "license": "MT22308074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prinn K Stang MD
• Priority Home Health Inc
• Proactive Mso, LLC
• Jaclin K Proctor, M.A., CCC-A

• Massage Therapist in Merrillville, IN
• Providers in Merrillville, IN by specialty
• Massage Therapist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.