Daniel Shane Jackson, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

11-03205 Issued in KS

Practice address

5501 NW 62ND Ter Ste 102
Kansas City, MO 64151-2412

Phone

(816) 453-4485

Fax

(816) 453-4101

NPI assigned

Jul 22, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Optimum Physical Therapy and Performance Center LLCGroup PAC ID 1052625340, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: daniel.jackson.1@11624.direct.athenahealth.com
• FHIR API: https://api.platform.athenahealth.com/583/brand/1/csg/1/fhir/r4

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.

• Optimum Physical Therapy & Performance Center, LLC

  • Physical Therapist
  • Kansas City, MO
  • NPI 1255728986
  Medicare reassignment Care Compare group NPD Authorized official
• Health Adminisource, LLC

  • Physical Therapist
  • Kansas City, MO
  • NPI 1770766982
  NPD (past)
• Consultants in Neurology, PA

  • Neurology Physician
  • Lenexa, KS
  • NPI 1134124746
  NPD (past)

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

{
    "created_epoch": "1121990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665014400000",
    "number": "1952301756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5501 NW 62ND TER STE 102",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641512412",
            "telephone_number": "816-453-4485",
            "fax_number": "816-453-4101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5501 NW 62ND TER STE 102",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641512412",
            "telephone_number": "816-453-4485",
            "fax_number": "816-453-4101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "DANIEL",
        "middle_name": "SHANE",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-22",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2002029465",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "KS",
            "license": "11-03205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony Earle Jackson
• Brandi L Jackson, DPT
• Breaunnah Bloomer Jackson, MD
• Casey Eden Jackson, PLPC
• Damita Jackson, CNA
• Dasia T Jackson
• Dawn M Jackson, MD
• Dorothy Jean Jackson, MD
• Frances Jackson
• Holly Jackson, LMSW

• Physical Therapist in Kansas City, MO
• Providers in Kansas City, MO by specialty
• Physical Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2022; 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.