Active NPI
Jordan Ann Hamilton, DPT
- Physical Therapist
- Bloomington, IN
National Provider Identifier
1962830760
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05011340A
- Practice address
- 1312 W Arch Haven Ave BLDG 1320
Ste E
Bloomington, IN 47403-2089 - Phone
- (812) 336-8406
- NPI assigned
- Oct 15, 2013
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 05011340A | IN | Primary |
| Physical Therapist | 225100000X | 10500 | AZ | |
| Physical Therapist | 225100000X | 070.020317 | IL |
Addresses
Primary practice location
1312 W Arch Haven Ave BLDG 1320
Ste E
Bloomington, IN 47403-2089
Mailing address
790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223
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 |
|---|---|---|---|
| 070.020317 | IL | MD | Physical Therapist |
| 05011340A | IN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1381795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398988800000",
"number": "1962830760",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "790 REMINGTON BLVD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604404909",
"telephone_number": "630-296-2223"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1312 W ARCH HAVEN AVE BLDG 1320",
"address_2": "STE E",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474032089",
"telephone_number": "812-336-8406"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAMILTON",
"first_name": "JORDAN",
"middle_name": "ANN",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-10-15",
"last_updated": "2014-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05011340A",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "10500",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070.020317",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.