Active NPI
William John Bacon, PTA
- Physical Therapy Assistant
- Webster, SD
National Provider Identifier
1902168669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 008793
- Practice address
- 902 E 12TH Ave
Webster, SD 57274-2300 - Phone
- (956) 451-1907
- NPI assigned
- Jun 8, 2012
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 2061050 | TX | |
| Physical Therapy Assistant | 225200000X | 008793 | NY | Primary |
Addresses
Primary practice location
902 E 12TH Ave
Webster, SD 57274-2300
Mailing address
902 E. 12TH Ave
Webster, SD 57274
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 |
|---|---|---|---|
| 2061050 | TX | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339113600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1594771200000",
"number": "1902168669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "902 E. 12TH AVE",
"city": "WEBSTER",
"state": "SD",
"postal_code": "57274"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "902 E 12TH AVE",
"city": "WEBSTER",
"state": "SD",
"postal_code": "572742300",
"telephone_number": "956-451-1907"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BACON",
"first_name": "WILLIAM",
"middle_name": "JOHN",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-06-08",
"last_updated": "2020-07-15",
"certification_date": "2020-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "TX",
"license": "2061050",
"primary": false
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NY",
"license": "008793",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Webster, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.