Active NPI
Jay T Mizuta, D.P.T.
- Physical Medicine & Rehabilitation Physician
- New York, NY
National Provider Identifier
1992126106
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Medicine & Rehabilitation Physician
- License
- 040302
- Practice address
- 535 E 70TH St
New York, NY 10021-4823 - Phone
- (212) 606-1005
- NPI assigned
- Dec 16, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 60309 | OR | |
| Physical Medicine & Rehabilitation Physician | 208100000X | 040302 | NY | Primary |
Addresses
Primary practice location
535 E 70TH St
New York, NY 10021-4823
Mailing address
16083 SW Upper Boones Ferry Rd
Suite 300
Tigard, OR 97224-7736
Phone (800) 219-8835
Other practice location 1
2925 River Rd S
Suite 200
Salem, OR 97302-3677
Phone (503) 585-4824
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 500666742 | Medicaid | OR |
Electronic endpoints 3
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | Mizutaj@hss.edu | Direct | |
| FHIR URL | https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/ | Direct | |
| Direct Messaging Address | mizutaj@hss.edu | Direct |
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 |
|---|---|---|---|
| 040302 | NY | MD | Physical Medicine & Rehabilitation Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Therapeutic Associates Inc | Physical Therapist | Past | Accepting new patients |
| Therapeutic Associates Inc | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Physical Therapist
- Bothell, WA
- NPI 1114376563
-
- Physical Therapist
- Portland, OR
- NPI 1700862000
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1387152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1617926400000",
"number": "1992126106",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16083 SW UPPER BOONES FERRY RD",
"address_2": "SUITE 300",
"city": "TIGARD",
"state": "OR",
"postal_code": "972247736",
"telephone_number": "800-219-8835",
"fax_number": "503-639-9699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "535 E 70TH ST",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100214823",
"telephone_number": "212-606-1005"
}
],
"practiceLocations": [
{
"address_1": "2925 River Rd S",
"address_2": "Suite 200",
"address_purpose": "LOCATION",
"city": "Salem",
"state": "OR",
"postal_code": "973023677",
"country_code": "US",
"telephone_number": "503-585-4824",
"fax_number": "503-370-2545",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MIZUTA",
"first_name": "JAY",
"middle_name": "T",
"credential": "D.P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-12-16",
"last_updated": "2021-04-09",
"certification_date": "2021-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OR",
"license": "60309",
"primary": false
},
{
"code": "208100000X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation",
"state": "NY",
"license": "040302",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "500666742",
"state": "OR"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "Mizutaj@hss.edu",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CCDI",
"address_1": "535 E 70th St",
"city": "New York",
"state": "NY",
"country_code": "US",
"postal_code": "100214823",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "FHIR",
"endpointTypeDescription": "FHIR URL",
"endpoint": "https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CCDA",
"address_1": "535 E 70th St",
"city": "New York",
"state": "NY",
"country_code": "US",
"postal_code": "100214823",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "mizutaj@hss.edu",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "CCDA",
"address_1": "535 E 70th St",
"city": "New York",
"state": "NY",
"country_code": "US",
"postal_code": "100214823",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.