Active NPI
Jada Gooch
- Occupational Therapist
- Port Orange, FL
National Provider Identifier
1891330759
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 19902
- Practice address
- 945 Windridge CT Apt a
Port Orange, FL 32127-4797 - Phone
- (607) 793-3397
- NPI assigned
- Nov 14, 2019
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 19902 | FL | Primary |
Addresses
Primary practice location
945 Windridge CT Apt a
Port Orange, FL 32127-4797
Mailing address
945 Windridge CT Apt a
Port Orange, FL 32127-4797
Phone (607) 793-3397
Other practice location 1
945 Windridge Ct Apt A
Port Orange, FL 32127-4797
Phone (607) 793-3397
Other practice location 2
911 N Spring Garden Ave
Deland, FL 32720-2560
Phone (386) 736-3108
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 19902 | FL | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premier Rehab Inc | Occupational Therapist | Past | Accepting new patients |
Organizations & group practices 1
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": "1573689600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1573689600000",
"number": "1891330759",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "945 WINDRIDGE CT APT A",
"city": "PORT ORANGE",
"state": "FL",
"postal_code": "321274797",
"telephone_number": "607-793-3397"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "945 WINDRIDGE CT APT A",
"city": "PORT ORANGE",
"state": "FL",
"postal_code": "321274797",
"telephone_number": "607-793-3397"
}
],
"practiceLocations": [
{
"address_1": "945 Windridge Ct Apt A",
"address_purpose": "LOCATION",
"city": "Port Orange",
"state": "FL",
"postal_code": "321274797",
"country_code": "US",
"telephone_number": "607-793-3397",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "911 N Spring Garden Ave",
"address_purpose": "LOCATION",
"city": "Deland",
"state": "FL",
"postal_code": "327202560",
"country_code": "US",
"telephone_number": "386-736-3108",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GOOCH",
"first_name": "JADA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-11-14",
"last_updated": "2019-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "FL",
"license": "19902",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port Orange, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.