Simon Gibson, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT13625 Issued in CA

Practice address

473 34TH St
Oakland, CA 94609-2815

Phone

(510) 339-2116

Fax

(510) 339-0647

NPI assigned

Jul 19, 2006

Last updated

Nov 9, 2012By the provider in NPPES

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1980

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Montclair Physical Therapy, Inc.

  dba Active Method Physical Therapy

  • Physical Therapist
  • Oakland, CA
  • NPI 1699791897
  Medicare reassignment
• Simon Gibson

  dba Montclair Physical Therapy

  • Physical Therapist
  • Oakland, CA
  • NPI 1497099451
  NPD (past) Authorized official
• Jay West Physical Therapy Inc

  • Physical Therapy Clinic/Center
  • Oakland, CA
  • NPI 1629651237

  Physical Therapist

  NPD (past)

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352419200000",
    "number": "1871512608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "473 34TH ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946092815",
            "telephone_number": "510-339-2116",
            "fax_number": "510-339-0647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "473 34TH ST",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946092815",
            "telephone_number": "510-339-2116",
            "fax_number": "510-339-0647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "SIMON",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2012-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT13625",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CA",
            "identifier": "PT13625",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Gibson
• Keneda M Gibson
• Nia N. Gibson
• Rejoyce Gibson
• Sabrina Elizabeth Gibson
• Cynthia Ann Gibsonhorn, PT
• Joyce Gidel, MFT
• Tatiana Marie Giel Matias
• Sheyna Elizabeth Gifford, MD
• Jacob Gigliotti

• Physical Therapist in Oakland, CA
• Providers in Oakland, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2012; 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.