Individual provider Active NPI

Jodi Elizabeth Sandvik, PT

  • Physical Therapist
  • Fort Wayne, IN
National Provider Identifier
1902167794
Registry record updated Jan 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
05013670A Issued in IN
Practice address
11143 Parkview Plaza Dr Ste 100
Fort Wayne, IN 46845-1728
Phone
(260) 266-7400
Fax
(260) 266-7439
NPI assigned
Jun 7, 2012
Last updated
Jan 5, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5501008684 MI
Physical Therapist 225100000X 05013670A IN Primary

Addresses

Primary practice location

11143 Parkview Plaza Dr Ste 100
Fort Wayne, IN 46845-1728

Mailing address

11109 Parkview Plaza Dr # 117
Fort Wayne, IN 46845-1701

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200325003625 IN Practitioner - Physical Therapist in Private Practice 4284888009 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
05013670AINMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Parkview Health System Inc CurrentSince May 24, 2023 Accepting new patients

Locations

817 Trail Ridge Rd
Albion, IN 46701
Phone (260) 373-9590

11109 Parkview Plaza Dr
#117
Fort Wayne, IN 46845
Phone (260) 266-6012

11130 Parkview Circle Dr
Fort Wayne, IN 46845
Phone (260) 266-6221

11143 Parkview Plaza Dr
Ste 100
Fort Wayne, IN 46845
Phone (260) 266-7400

3702 New Vision Dr
Bldg B
Fort Wayne, IN 46845
Phone (260) 266-8210

3909 New Vision Dr
Fort Wayne, IN 46845
Phone (260) 373-8000

512 Professional Way
Kendallville, IN 46755
Phone (260) 347-8556

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1339027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609804800000",
    "number": "1902167794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11109 PARKVIEW PLAZA DR # 117",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11143 PARKVIEW PLAZA DR STE 100",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451728",
            "telephone_number": "260-266-7400",
            "fax_number": "260-266-7439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDVIK",
        "first_name": "JODI",
        "middle_name": "ELIZABETH",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-07",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501008684",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05013670A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.