Christopher Carl Jackson, PHYSICAL THERAPIST

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

06912 Issued in LA

Practice address

12739 Highway 171 Ste B
Longville, LA 70652-5050

Phone

(337) 317-9290

Fax

(337) 725-4457

NPI assigned

Apr 5, 2018

Sex

Male

Sole proprietor

Yes

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 LA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• SB Physical Therapy and Sports Rehab

  • Physical Therapist
  • Longville, LA
  • NPI 1619466356

  LA, Single Specialty

  Medicare reassignment NPD

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

{
    "created_epoch": "1522886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613520000000",
    "number": "1972009041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12739 HIGHWAY 171 STE B",
            "city": "LONGVILLE",
            "state": "LA",
            "postal_code": "706525050",
            "telephone_number": "337-317-9290",
            "fax_number": "337-725-4457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12739 HIGHWAY 171 STE B",
            "city": "LONGVILLE",
            "state": "LA",
            "postal_code": "706525050",
            "telephone_number": "337-317-9290",
            "fax_number": "337-725-4457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "CHRISTOPHER",
        "middle_name": "CARL",
        "name_prefix": "Mr.",
        "credential": "PHYSICAL THERAPIST",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-05",
        "last_updated": "2021-02-17",
        "certification_date": "2021-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "LA",
            "license": "06912",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beauregard Medical Group LLC
• Randi Bullard, DPT
• Diabetes & Obesity Control LLC
• Sarah Elizabeth Ewing, PT, DPT
• Jeremy Romaine Leblanc
• Laura Ellen Neely, M.S., CCC-SLP
• Taylor Raymond
• SB Physical Therapy and Sports Rehab
• South Beauregard Health Center, L.L.C.

• All providers in Longville, LA
• Physical Therapist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2021; 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.