Individual provider Active NPI

Jeffery Michael Deatherage, D.C.

  • Rehabilitation Chiropractor
  • Rancho Mirage, CA
National Provider Identifier
1962784595
Registry record updated Mar 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation ChiropractorTaxonomy code 111NR0400X
License
16116 Issued in TX
Practice address
36101 Bob Hope Dr Ste a
Rancho Mirage, CA 92270-2001
Phone
(760) 321-1315
Fax
(760) 321-1094
NPI assigned
Sep 9, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 4, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Chiropractor 111NR0400X 16116 TX Primary

Addresses

Primary practice location

36101 Bob Hope Dr Ste a
Rancho Mirage, CA 92270-2001

Mailing address

36101 Bob Hope Dr Ste a
Rancho Mirage, CA 92270-2001
Phone (760) 321-1315

Other identifiers 1

IdentifierTypeStateIssuer
16116OtherTXCHIROPRACTIC LICENSE

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address records@airrosti-rehab-ctrs.direct.kno2fy.com Airrosti Rehab Centers, LLC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251113002336 CA Practitioner - Chiropractic 4880836923 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

200 N Bryant Ave
Edmond, OK 73034-6273

44630 Monterey Ave
Suite 100
Palm Desert, CA 92260-3326

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Tobias Moeller-Bertram MD Corporation CurrentSince Jul 31, 2025 Accepting new patients
Tobias Moeller-Bertram MD Corporation CurrentSince Jul 31, 2025 Accepting new patients
Airrosti Rehab Centers Chiropractor Past Accepting new patients

Locations

44630 Monterey Ave
Ste 100
Palm Desert, CA 92260
Phone (760) 340-4290

36101 Bob Hope Dr
Ste A1
Rancho Mirage, CA 92270
Phone (760) 321-1315

36101 Bob Hope Dr
Ste A
Rancho Mirage, CA 92270
Phone (760) 321-1315

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.

NPI Registry JSON

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

{
    "created_epoch": "1315526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772582400000",
    "number": "1962784595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36101 BOB HOPE DR STE A",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922702001",
            "telephone_number": "760-321-1315",
            "fax_number": "760-321-1094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36101 BOB HOPE DR STE A",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922702001",
            "telephone_number": "760-321-1315",
            "fax_number": "760-321-1094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEATHERAGE",
        "first_name": "JEFFERY",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-09",
        "last_updated": "2026-03-04",
        "certification_date": "2026-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "TX",
            "license": "16116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROPRACTIC LICENSE",
            "identifier": "16116",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "records@airrosti-rehab-ctrs.direct.kno2fy.com",
            "affiliation": "Y",
            "affiliationName": "Airrosti Rehab Centers, LLC",
            "address_1": "111 Tower Dr Bldg 1",
            "city": "San Antonio",
            "state": "TX",
            "country_code": "US",
            "postal_code": "782323625",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rancho Mirage, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2026; 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.