Individual provider Active NPI

Jessica Dejong

  • Physical Therapist
  • Tinley Park, IL
National Provider Identifier
1013735398
Registry record updated Sep 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
17236 Harlem Ave
Tinley Park, IL 60477-6619
Phone
(708) 633-8379
NPI assigned
Sep 26, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 26, 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 Primary

Addresses

Primary practice location

17236 Harlem Ave
Tinley Park, IL 60477-6619

Mailing address

17236 Harlem Ave
Tinley Park, IL 60477-6619

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241024002504 IL Practitioner - Physical Therapist in Private Practice 5092248369 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

13114 Western Ave
Suite 3
Blue Island, IL 60406-2440
Phone (708) 824-0515

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Pathology, PLLC CurrentSince Oct 14, 2024 Accepting new patients
Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Path Physical Therapist CurrentSince Oct 14, 2024 Accepting new patients

Locations

13114 Western Ave
Ste 3
Blue Island, IL 60406
Phone (708) 335-4081

204 E Washington St
Clinton, IL 61727
Phone (217) 570-0225

2 River Pl
Ste B
Lansing, IL 60438
Phone (708) 895-9860

2777 Maple Ave
Lisle, IL 60532
Phone (630) 326-8810

1624 S Route 59
Ste 100
Naperville, IL 60564
Phone (331) 249-4088

9763 W 143rd St
Ste C
Orland Park, IL 60462
Phone (708) 226-1991

17236 Harlem Ave
Ste 140
Tinley Park, IL 60477

17236 Harlem Ave
Tinley Park, IL 60477
Phone (708) 633-8379

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": "1727308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727308800000",
    "number": "1013735398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17236 HARLEM AVE",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604776619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17236 HARLEM AVE",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604776619",
            "telephone_number": "708-633-8379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEJONG",
        "first_name": "JESSICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-09-26",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tinley Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 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.