Brent A Panno, OT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

056.010064 Issued in IL

Practice address

800 Des Plaines Ave
Forest Park, IL 60130-2035

Phone

(708) 366-2442

Fax

(708) 366-0179

NPI assigned

May 13, 2015

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 WA

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Outpatient Physical Therapy and Sports Rehabilitation Inc PCGroup PAC ID 3678487063, 30 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 and National Provider Directory roles.

• Outpatient Physical Therapy & Sports Rehabilitation Inc PC

  • Physical Therapist
  • Maple Valley, WA
  • NPI 1730394420
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1431475200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433376000000",
    "number": "1063890879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2222",
            "fax_number": "630-759-9510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 DES PLAINES AVE",
            "city": "FOREST PARK",
            "state": "IL",
            "postal_code": "601302035",
            "telephone_number": "708-366-2442",
            "fax_number": "708-366-0179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANNO",
        "first_name": "BRENT",
        "middle_name": "A",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-13",
        "last_updated": "2015-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056.010064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Stuti Patel
• Jamie M Pautsch, OT
• Kaylee Pavlik
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• Occupational Therapist in Forest Park, IL
• Providers in Forest Park, IL by specialty
• Occupational Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2015; 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.