Individual provider Active NPI

Jodeon Davis

  • Physical Therapist
  • Bronx, NY
National Provider Identifier
1952819021
Registry record updated Jan 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
1250 Waters PL Ste 1205
Bronx, NY 10461-2720
Phone
(347) 810-7777
NPI assigned
Jan 11, 2018
Last updated
Jan 11, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2018

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 NU Primary

Addresses

Primary practice location

1250 Waters PL Ste 1205
Bronx, NY 10461-2720

Mailing address

2142 Utopia Pkwy
Whitestone, NY 11357-4142
Phone (718) 819-6805

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180119000281 NY Practitioner - Physical Therapist in Private Practice 3375802317 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

123 Grove Ave
Cedarhurst, NY 11516-2322
Phone (516) 374-4248

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
042692NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Occupational & Physical Therapy, PLLC Physical Therapist CurrentSince Jan 15, 2018 Accepting new patients
Professional Occupational & Physical Therapy, PLLC Physical Therapist Current Accepting new patients
Professional Occupational & Physical Therapy, PLLC Physical Therapist CurrentSince Jan 15, 2018 Accepting new patients

Locations

1250 Waters Pl
Ste 1205
Bronx, NY 10461
Phone (347) 810-7777

123 Grove Ave
Cedarhurst, NY 11516
Phone (516) 374-4248

90 Northern Blvd
Greenvale, NY 11548
Phone (516) 626-5080

576 Broadhollow Rd
Melville, NY 11747

16 E 52nd St
Fl 6
New York, NY 10022
Phone (212) 752-2400

2142 Utopia Pkwy
Whitestone, NY 11357
Phone (718) 767-0610

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1515628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1515628800000",
    "number": "1952819021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2142 UTOPIA PKWY",
            "city": "WHITESTONE",
            "state": "NY",
            "postal_code": "113574142",
            "telephone_number": "718-819-6805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 WATERS PL STE 1205",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104612720",
            "telephone_number": "347-810-7777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "JODEON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-01-11",
        "last_updated": "2018-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2018; 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.