Jack Joel Little, is a medicare enrolled "Physical Therapist" physician in Peoria, Arizona. His current practice location is
9000 W Thunderbird Rd # 205, Peoria, Arizona. You can reach out to his office (for appointments etc.) via phone at
(602) 491-1948.
Jack Joel Little is licensed to practice in Arizona (license number LPT-30858) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1669029609.
Physician's Profile
| Full Name | Jack Joel Little |
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| Gender | Male |
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| Speciality | Physical Therapist |
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| Location | 9000 W Thunderbird Rd # 205, Peoria, Arizona |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1669029609
- Provider Enumeration Date: 08/23/2019
- Last Update Date: 10/31/2024
Medicare PECOS Information:
- PECOS PAC ID: 8022348119
- Enrollment ID: I20191003000735
Medical Identifiers
Medical identifiers for Jack Joel Little such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
| 1669029609 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
| 208100000X | Physical Medicine & Rehabilitation | 30858 (Arizona) | Secondary |
| 225100000X | Physical Therapist | LPT-30858 (Arizona) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Jack Joel Little allows following entities to bill medicare on his behalf.
| Entity Name | Ati Holdings Of Arizona Llc |
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| Entity Type | Part B Supplier - Physical/occupational Therapy Group In Private Practice |
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| Entity Identifiers | NPI Number: 1871570309 PECOS PAC ID: 2466732862 Enrollment ID: O20161130001683 |
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| Entity Name | Mountain View Pain Center |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1215179304 PECOS PAC ID: 1052469152 Enrollment ID: O20230503000712 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jack Joel Little is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
Jack Joel Little, 5445 Dtc Pkwy Ste 1130, Greenwood Village, CO 80111-3038 Ph: (720) 749-5599 | Jack Joel Little, 9000 W Thunderbird Rd # 205, Peoria, AZ 85381-4451 Ph: (602) 491-1948 |
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