Rita Rae Graham, NCTMB

Primary specialty

SpecialistTaxonomy code 174400000X

License

227008684 Issued in IL

Practice address

1244 American Way
Libertyville, IL 60048-3936

Phone

(847) 549-9595

Fax

(847) 549-9596

NPI assigned

Sep 14, 2009

Sex

Female

Sole proprietor

No

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.

• Dr. Reena Jacob LTD

  • Chiropractor
  • Libertyville, IL
  • NPI 1477824357
  NPD (past)
• Shalom Ex-Import, Inc.

  • Physical Therapist
  • Libertyville, IL
  • NPI 1225351216
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 14, 2009.

{
    "created_epoch": "1252886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1252886400000",
    "number": "1003149766",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1244 AMERICAN WAY",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600483936",
            "telephone_number": "847-549-9595",
            "fax_number": "847-549-9596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1244 AMERICAN WAY",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600483936",
            "telephone_number": "847-549-9595",
            "fax_number": "847-549-9596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "RITA",
        "middle_name": "RAE",
        "name_prefix": "Mrs.",
        "credential": "NCTMB",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-14",
        "last_updated": "2009-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "227008684",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hazel Mae Gordon
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• Alexander T Gough, DPT
• Kim Michael Graff, RPH
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• Eliza Eva M. Grant, CNP
• Trysta Allyson Grassel, RBT

• All providers in Libertyville, IL
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.