Jacob Mitchell Boehme, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

31677 Issued in AZ

Practice address

6021 S Kings Ranch Rd Ste 5
Gold Canyon, AZ 85118-4774

Phone

(480) 982-7948

Fax

(480) 982-9145

NPI assigned

Mar 18, 2021

Last updated

Sep 16, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Moore Physical Therapy PLCGroup PAC ID 6103815212, 13 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Moore Physical Therapy PLC

  • Physical Therapist
  • Mesa, AZ
  • NPI 1538258991
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1616025600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726444800000",
    "number": "1952987190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 S POWER RD STE 123",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852096688",
            "telephone_number": "480-218-1344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6021 S KINGS RANCH RD STE 5",
            "city": "GOLD CANYON",
            "state": "AZ",
            "postal_code": "851184774",
            "telephone_number": "480-982-7948",
            "fax_number": "480-982-9145"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2500 S Power Rd Ste 123",
            "address_purpose": "LOCATION",
            "city": "Mesa",
            "state": "AZ",
            "postal_code": "852096688",
            "country_code": "US",
            "telephone_number": "480-218-1344",
            "fax_number": "480-218-1356",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOEHME",
        "first_name": "JACOB",
        "middle_name": "MITCHELL",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-03-18",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "31677",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Az Whole Heart Connection, LLC
• Danielle Bailey
• Derek Bawden
• Kevin Bell, PA
• Edward James Bodmer, DPM
• Leanna Rae Bond, RDH
• Amber Bratcher, DPT
• Ryan Wade Brower, PA-C
• James Joseph Burnis, DIPL.AC., L.AC.
• Lars John Carlson, O.D.

• Physical Therapist in Gold Canyon, AZ
• Providers in Gold Canyon, AZ by specialty
• Physical Therapist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; 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.