Individual provider Active NPI

Justin Emil Tepen, D.P.T.

  • Physical Therapist
  • Columbia, MO
National Provider Identifier
1922334598
Registry record updated Jun 25, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
2009033455 Issued in MO
Practice address
303 N Keene St
Suite 102
Columbia, MO 65201-7193
Phone
(573) 443-0225
Fax
(573) 443-0290
NPI assigned
Nov 2, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2009033455 MO Primary

Addresses

Primary practice location

303 N Keene St
Suite 102
Columbia, MO 65201-7193

Mailing address

109 N Lincoln Dr
Ste a
Troy, MO 63379-1426
Phone (573) 489-8393

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100108000342 MO Practitioner - Physical Therapist in Private Practice 0840331112 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jet Therapy LLCGroup PAC ID 5092030254, 3 clinicians

Practice addresses (Care Compare)

109 N Lincoln Dr
Suite a
Troy, MO 63379-1426
Phone (636) 775-9200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2009033455MOMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Jet Therapy LLC Physical Therapist CurrentSince Jan 5, 2015 Accepting new patients
Westside Rehab, Inc Past Accepting new patients

Locations

109 N Lincoln Dr
Ste A
Troy, MO 63379
Phone (616) 356-1121

Organizations & group practices 2

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": "1257120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624579200000",
    "number": "1922334598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "109 N LINCOLN DR",
            "address_2": "STE A",
            "city": "TROY",
            "state": "MO",
            "postal_code": "633791426",
            "telephone_number": "573-489-8393",
            "fax_number": "573-443-0290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 N KEENE ST",
            "address_2": "SUITE 102",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652017193",
            "telephone_number": "573-443-0225",
            "fax_number": "573-443-0290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEPEN",
        "first_name": "JUSTIN",
        "middle_name": "EMIL",
        "credential": "D.P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-11-02",
        "last_updated": "2021-06-25",
        "certification_date": "2021-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2009033455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2021; 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.