Active NPI
Jennifer Medeiros, PT
- Physical Therapist
- Worcester, MA
National Provider Identifier
1952380297
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 16230
- Practice address
- 135 Gold Star Blvd
Worcester, MA 01606 - Phone
- (508) 856-9510
- Fax
- (508) 853-1907
- NPI assigned
- Jan 14, 2006
- 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 | 16230 | MA | Primary |
Addresses
Primary practice location
135 Gold Star Blvd
Worcester, MA 01606
Mailing address
630 Plantation St
Wot 12TH Floor Attn Physician Services
Worcester, MA 01605
Phone (508) 368-5529
Other identifiers 11
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04 2472266 | Other | THREE RIVERS | |
| 67906 | Other | FALLON COMMUNITY HEALTH P | |
| 042472266 | Other | PRIVATE HEALTHCARE SYSTEM | |
| Y68323 | Other | BLUE CARE ELECT | |
| 04 2472266 | Other | ONE HEALTH PLAN | |
| Y68323 | Other | BLUE SHIELD HMO BLUE | |
| Y69329 | Other | MEDICARE B | |
| 2225131 | Other | FIRST HEALTH | |
| 785960 | Other | MVP HEALTH CARE | |
| Y68323 | Other | BLUE SHIELD INDEMNITY | |
| 7353622 | Other | AETNA US HEALTHCARE |
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 |
|---|---|---|---|
| 16230 | MA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137196800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217376000000",
"number": "1952380297",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "630 PLANTATION ST",
"address_2": "WOT 12TH FLOOR ATTN PHYSICIAN SERVICES",
"city": "WORCESTER",
"state": "MA",
"postal_code": "01605",
"telephone_number": "508-368-5529",
"fax_number": "508-368-5530"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "135 GOLD STAR BLVD",
"city": "WORCESTER",
"state": "MA",
"postal_code": "01606",
"telephone_number": "508-856-9510",
"fax_number": "508-853-1907"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDEIROS",
"first_name": "JENNIFER",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-14",
"last_updated": "2008-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MA",
"license": "16230",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "THREE RIVERS",
"identifier": "04 2472266",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FALLON COMMUNITY HEALTH P",
"identifier": "67906",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRIVATE HEALTHCARE SYSTEM",
"identifier": "042472266",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CARE ELECT",
"identifier": "Y68323",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ONE HEALTH PLAN",
"identifier": "04 2472266",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD HMO BLUE",
"identifier": "Y68323",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE B",
"identifier": "Y69329",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST HEALTH",
"identifier": "2225131",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MVP HEALTH CARE",
"identifier": "785960",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD INDEMNITY",
"identifier": "Y68323",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA US HEALTHCARE",
"identifier": "7353622",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
- Emily Meara, MD
- Rachael Measer, LICSW, MSW
- Rumali S. Medagoda, M.D.
- Sandra Medakovich, NP
- Peter Medawar
- Paul Michael Medeiros, OTR/L
- Medi-Rents, Inc (Praxair Healthcare Services)
- Medical Billing and Collections, LLC (Home Health Services)
- Medical Center West Podiatry Associates, Inc.
- Medical Choice Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.