NPIMap

Organization Active NPI

Wellness Club, LTD

  • Physical Therapy Clinic/Center
  • Bannockburn, IL
National Provider Identifier
1043895832
Registry record updated Jun 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
Legal business name
WELLNESS CLUB, LTD
Practice address
2223 Lakeside Dr
Bannockburn, IL 60015-1265
Phone
(847) 920-4040
Fax
(947) 920-4012
NPI assigned
Mar 12, 2021
Last updated
Jun 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2024

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

Authorized official

Name
Veronica ShakhnisNPI 1306430335
Title
President
Phone
(773) 983-3475

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X NU Primary
Chiropractor 111N00000X NU
Acupuncturist 171100000X NU
Massage Therapist 225700000X NU

Addresses

Primary practice location

2223 Lakeside Dr
Bannockburn, IL 60015-1265

Mailing address

2223 Lakeside Dr
Bannockburn, IL 60015-1265
Phone (847) 920-4040

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL Vshakhnis@gmail.com Other

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210511001505 IL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4981013521 Receives reassigned benefits from 1 practitioner
Practice locations: Bannockburn, IL

National Provider Directory

National Provider Directory

Locations

2223 Lakeside Dr
Bannockburn, IL 60015
Phone (773) 983-3475

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1615507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719273600000",
    "number": "1043895832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2223 LAKESIDE DR",
            "city": "BANNOCKBURN",
            "state": "IL",
            "postal_code": "600151265",
            "telephone_number": "847-920-4040",
            "fax_number": "847-920-4012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2223 LAKESIDE DR",
            "city": "BANNOCKBURN",
            "state": "IL",
            "postal_code": "600151265",
            "telephone_number": "847-920-4040",
            "fax_number": "947-920-4012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WELLNESS CLUB, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-12",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A",
        "authorized_official_last_name": "SHAKHNIS",
        "authorized_official_first_name": "VERONICA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "773-983-3475"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Vshakhnis@gmail.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Email",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1535 Lake Cook Rd Ste 102",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600621450",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bannockburn, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2024; 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.