Individual provider Active NPI

Janice M Smith-White, PT

  • Physical Therapist
  • Willowbrook, IL
National Provider Identifier
1013069731
Registry record updated Nov 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070004413 Issued in IL
Practice address
66 W 63Rd St
Willowbrook, IL 60527-7576
Phone
(630) 439-4661
Fax
(630) 596-2455
NPI assigned
Jan 16, 2007
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070004413 IL Primary

Addresses

Primary practice location

66 W 63Rd St
Willowbrook, IL 60527-7576

Mailing address

404 E. Naperville Rd
Clarendon Hills, IL 60514
Phone (630) 439-4661

Other identifiers 1

IdentifierTypeStateIssuer
01633773OtherILBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040419000094 IL Practitioner - Physical Therapist in Private Practice 4082609177 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

66 W 63Rd St
Willowbrook, IL 60527-2982
Phone (630) 439-4661

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070004413ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
The Sports Medicine and Regenerative Therapeutics Institute CurrentSince Sep 8, 2024 Accepting new patients

Locations

12 Salt Creek Ln
Ste 300
Hinsdale, IL 60521
Phone (630) 850-7901

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/13990/brand/1/csg/1/fhir/r4
  • Direct secure messaging: janice.smith-white.1@13990.direct.athenahealth.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731628800000",
    "number": "1013069731",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 E. NAPERVILLE RD",
            "city": "CLARENDON HILLS",
            "state": "IL",
            "postal_code": "60514",
            "telephone_number": "630-439-4661",
            "fax_number": "630-596-2455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 W 63RD ST",
            "city": "WILLOWBROOK",
            "state": "IL",
            "postal_code": "605277576",
            "telephone_number": "630-439-4661",
            "fax_number": "630-596-2455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH-WHITE",
        "first_name": "JANICE",
        "middle_name": "M",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-16",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070004413",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "01633773",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Willowbrook, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.