Jesus Antonio Prado

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

300647 Issued in CA

Practice address

23 Reed Blvd
Mill Valley, CA 94941-2334

Phone

(415) 888-2289

NPI assigned

Aug 23, 2021

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 CA

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

Presidio Sport and Medicine, Inc.Group PAC ID 2466447651, 18 clinicians

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Presidio Sport & Medicine, Inc.

  • Physical Therapist
  • San Francisco, CA
  • NPI 1578565149

  Physical Therapy

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1629676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629676800000",
    "number": "1982370581",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2830 PINE ST",
            "city": "NAPA",
            "state": "CA",
            "postal_code": "945585829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 REED BLVD",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "949412334",
            "telephone_number": "415-888-2289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRADO",
        "first_name": "JESUS",
        "middle_name": "ANTONIO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-08-23",
        "last_updated": "2021-08-23",
        "certification_date": "2021-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "CA",
            "license": "300647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Point Practice Inc
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• Physical Therapy Clinic/Center in Mill Valley, CA
• Providers in Mill Valley, CA by specialty
• Physical Therapy Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 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.