NPIMap

Organization Active NPI

Integrated Physical Medicine of Naperville PLLC

  • Chiropractor
  • Naperville, IL
National Provider Identifier
1013559020
Registry record updated Feb 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
INTEGRATED PHYSICAL MEDICINE OF NAPERVILLE PLLC
Practice address
2155 City Gate LN Ste 123
Naperville, IL 60563-7733
Phone
(331) 249-3999
Fax
(331) 249-4029
NPI assigned
Oct 10, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2020

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

Authorized official

Name
Dr. Jonathan Mark Polcyn, DCNPI 1982817813
Title
Co-Owner/Clinic Director
Phone
(331) 249-3999

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

2155 City Gate LN Ste 123
Naperville, IL 60563-7733

Mailing address

2155 City Gate LN Ste 123
Naperville, IL 60563-7733
Phone (331) 249-3999

Other names 1

  • Integrated Physical Medicine Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200213001353 IL Part B Supplier - Clinic/Group Practice 0749616647 Receives reassigned benefits from 1 practitioner
Practice locations: Naperville, IL

National Provider Directory

National Provider Directory

Locations

2155 City Gate Ln
Ste 123
Naperville, IL 60563
Phone (331) 249-3999

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1570665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582848000000",
    "number": "1013559020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2155 CITY GATE LN STE 123",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605637733",
            "telephone_number": "331-249-3999",
            "fax_number": "331-249-4029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2155 CITY GATE LN STE 123",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605637733",
            "telephone_number": "331-249-3999",
            "fax_number": "331-249-4029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED PHYSICAL MEDICINE OF NAPERVILLE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-10",
        "last_updated": "2020-02-28",
        "certification_date": "2020-02-28",
        "status": "A",
        "authorized_official_last_name": "POLCYN",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "CO-OWNER/CLINIC DIRECTOR",
        "authorized_official_telephone_number": "331-249-3999",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Integrated Physical Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Naperville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2020; 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.