Individual provider Active NPI

Kimberly Grote, PT

  • Physical Therapist
  • New Lenox, IL
National Provider Identifier
1053429787
Registry record updated May 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070-010309 Issued in IL
Practice address
751 E Lincoln Hwy
New Lenox, IL 60451-1984
Phone
(630) 967-2000
Fax
(630) 653-4812
NPI assigned
Aug 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2023

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 070-010309 IL Primary

Addresses

Primary practice location

751 E Lincoln Hwy
New Lenox, IL 60451-1984

Mailing address

PO Box 713260
Chicago, IL 60677-1260
Phone (630) 469-9200

Other names 1

  • Kimberly Connelly Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kgrote249448@dulyhealthandcare.direct-ci.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071102000698 IL Practitioner - Physical Therapist in Private Practice 4082701396 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dupage Medical Group LTDGroup PAC ID 5496667941, 1,326 clinicians

Practice addresses (Care Compare)

1325 N Meacham Rd
Schaumburg, IL 60173-4824
Phone (630) 469-9200

751 E Lincoln Hwy
New Lenox, IL 60451-1984
Phone (630) 967-2000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070-010309ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Health4Life Chiropractic, Inc PastSince Aug 1, 2012 Accepting new patients
Athletic and Therapeutic Institute of Joliet LLC Physical Therapist Past Accepting new patients
Athletic &Therapeutic Institute of Naperville, LLC Physical Therapist Past Accepting new patients

Organizations & group practices 4

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": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685059200000",
    "number": "1053429787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 713260",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606771260",
            "telephone_number": "630-469-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 E LINCOLN HWY",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604511984",
            "telephone_number": "630-967-2000",
            "fax_number": "630-653-4812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROTE",
        "first_name": "KIMBERLY",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-25",
        "last_updated": "2023-05-26",
        "certification_date": "2023-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070-010309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kgrote249448@dulyhealthandcare.direct-ci.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "751 E Lincoln Hwy",
            "city": "New Lenox",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604511984",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "CONNELLY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in New Lenox, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2023; 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.