Jacob Kelso, DPT
NPI 1518472059ActiveIndividual· Physical Therapist· Mesa, AZ
Physical Therapist (DPT) with Modern Sports Medicine LLC and 1 other group, practicing in Mesa, Arizona. Medicare paid $97,748 for services to 152 patients in 2024.
Overview
| NPI | 1518472059 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | DPT |
| Sole proprietor | No |
| NPI issued | Dec 6, 2017 |
| Last updated in NPPES | Apr 9, 2021 |
| Certified by provider | Apr 9, 2021 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physical Therapist Primary | 225100000X | 13450 | AZ |
| Physical Therapist, Orthopedic | 2251X0800X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Practitioner - Physical Therapist in Private Practice (AZ) |
|---|---|
| Accepts assignment | Yes (participating) |
Medicare services in 2024
| Medicare patients | 152 |
|---|---|
| Services billed | 5,063 across 15 procedure codes |
| Paid by Medicare | $97,748 |
Education and affiliations
| Graduation year | 2017 |
|---|---|
| Medicare specialty | Physical Therapist In Private Practice |
Medical groups
- Modern Sports Medicine LLCGilbert, AZ · 42 clinicians
- Petkov Bodywork Therapy LLCGlendale, AZ · 15 clinicians
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All 484 physical therapists in Mesa · All physical therapists in Arizona