Active NPI
Jessica Jutte Bertram, PT, DPT
- Physical Therapist
- Grapevine, TX
National Provider Identifier
1942459953
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 1167472
- Practice address
- 1643 Lancaster Dr.
Suite 100
Grapevine, TX 76051 - Phone
- (817) 329-2524
- Fax
- (817) 329-2685
- NPI assigned
- Sep 15, 2008
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 1167472 | TX | Primary |
Addresses
Primary practice location
1643 Lancaster Dr.
Suite 100
Grapevine, TX 76051
Mailing address
1643 Lancaster Dr.
Suite 100
Grapevine, TX 76051
Phone (817) 329-2524
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 |
|---|---|---|---|
| 1167472 | TX | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bir JV LLP | Past | Accepting new patients | |
| TLC Lymphedema and Physical Therapypllc | Physical Therapist | Past | Accepting new patients |
| Dallas Nephrology Associates | Past | Accepting new patients |
Interoperability endpoints
- https://epicproxy.et1041.epichosted.com/FHIRProxy/api/FHIR/R4/
Organizations & group practices 3
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.
-
dba Baylor Institute for Rehabilitation
- Rehabilitation Hospital
- Dallas, TX
- NPI 1538465901
-
dba Dallas Nephrology Associates Vascular Center Dallas
- Ambulatory Surgical Clinic/Center
- Dallas, TX
- NPI 1053634030
-
- Physical Therapist
- Dallas, TX
- NPI 1194801670
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1221436800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623628800000",
"number": "1942459953",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1643 LANCASTER DR.",
"address_2": "SUITE 100",
"city": "GRAPEVINE",
"state": "TX",
"postal_code": "76051",
"telephone_number": "817-329-2524",
"fax_number": "817-329-2685"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1643 LANCASTER DR.",
"address_2": "SUITE 100",
"city": "GRAPEVINE",
"state": "TX",
"postal_code": "76051",
"telephone_number": "817-329-2524",
"fax_number": "817-329-2685"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERTRAM",
"first_name": "JESSICA",
"middle_name": "JUTTE",
"name_prefix": "Mrs.",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-09-15",
"last_updated": "2021-06-14",
"certification_date": "2021-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "TX",
"license": "1167472",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Grapevine, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.