NPIMap

Organization Active NPI

Campus Commons Physical Therapy, Inc.

  • Physical Therapist
  • Sacramento, CA
National Provider Identifier
1992787477
Registry record updated Nov 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
CAMPUS COMMONS PHYSICAL THERAPY, INC.
Practice address
601 University Ave Ste 185
Sacramento, CA 95825-6739
Phone
(916) 927-1333
Fax
(916) 927-1586
NPI assigned
Nov 18, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2017

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

Authorized official

Name
Mark D Eddy, P.T.NPI 1548278542
Title
Owner
Phone
(916) 927-1333

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X

Addresses

Primary practice location

601 University Ave Ste 185
Sacramento, CA 95825-6739

Mailing address

601 University Ave Ste 185
Sacramento, CA 95825-6739
Phone (916) 927-1333

Other identifiers 4

IdentifierTypeStateIssuer
ZZZ03086ZOtherBLUE SHIELD
197554800OtherDOL
DA1522OtherCARAILROAD
5318800OtherCACIGNA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090414000301 CA Part B Supplier - Clinic/Group Practice 2668377060 Receives reassigned benefits from 11 practitioners
Practice locations: Sacramento, CA

National Provider Directory

National Provider Directory
Tax ID family
Campus Commons Physical Therapy3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

601 University Ave
Ste 185
Sacramento, CA 95825
Phone (916) 927-1333

Practitioners & affiliated clinicians

Practitioners 23

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1132272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1511740800000",
    "number": "1992787477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 UNIVERSITY AVE STE 185",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958256739",
            "telephone_number": "916-927-1333",
            "fax_number": "916-927-1586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 UNIVERSITY AVE STE 185",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958256739",
            "telephone_number": "916-927-1333",
            "fax_number": "916-927-1586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMPUS COMMONS PHYSICAL THERAPY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-18",
        "last_updated": "2017-11-27",
        "status": "A",
        "authorized_official_last_name": "EDDY",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "916-927-1333",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ03086Z",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOL",
            "identifier": "197554800",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "DA1522",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "5318800",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sacramento, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.