Andrew Clevenger

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070.028039 Issued in IL

Practice address

2121 W Roscoe St
Chicago, IL 60618-9244

Phone

(312) 586-1185

NPI assigned

Jan 30, 2024

Last updated

Jan 30, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Revolution PTWL LLCGroup PAC ID 7719115617, 42 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Revolution PTWL LLC

  dba Revolution Physical Therapy Weight Loss

  • Physical Therapist
  • Chicago, IL
  • NPI 1164766606
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1706572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1033971411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 W ROSCOE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606189244",
            "telephone_number": "312-586-1185",
            "fax_number": "312-586-1083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 W ROSCOE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606189244",
            "telephone_number": "312-586-1185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEVENGER",
        "first_name": "ANDREW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-01-30",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.028039",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Cleveland
• Beatrice Hyde Cleveland, LCSW
• Emily Frances Mary Cleveland, OTR
• Lauren Faith Cleveland, PT, DPT
• Noa K Cleveland
• Charles Clevenger, MD
• Sarah Clevenger, DPT
• Clicc LLC
• Client Care Transport LLC
• Client Direct, LLC

• Physical Therapist in Chicago, IL
• Providers in Chicago, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 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.