Active NPI
Samuel Kegerreis, PT/ATC
- Physical Therapist
- Indianapolis, IN
National Provider Identifier
1942409982
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05001348A
- Practice address
- 201 Pennsylvania Pkwy
Ste 100
Indianapolis, IN 46280-2301 - Phone
- (317) 817-1200
- Fax
- (317) 208-1551
- NPI assigned
- Jul 11, 2007
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 05001348A | IN | Primary |
Addresses
Primary practice location
201 Pennsylvania Pkwy
Ste 100
Indianapolis, IN 46280-2301
Mailing address
201 Pennsylvania Pkwy
Suite 100
Indianapolis, IN 46280-2301
Phone (317) 817-1200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201003100 | Medicaid | IN |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05001348A | IN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1297296000000",
"number": "1942409982",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "201 PENNSYLVANIA PKWY",
"address_2": "SUITE 100",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462802301",
"telephone_number": "317-817-1200",
"fax_number": "317-208-1551"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 PENNSYLVANIA PKWY",
"address_2": "STE 100",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462802301",
"telephone_number": "317-817-1200",
"fax_number": "317-208-1551"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KEGERREIS",
"first_name": "SAMUEL",
"credential": "PT/ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-11",
"last_updated": "2011-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05001348A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201003100",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.