Individual provider Active NPI

Dakota John Greenwalt, DPT

  • Physical Therapist
  • Chicago, IL
National Provider Identifier
1073226510
Registry record updated Apr 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070027339 Issued in IL
Practice address
2869 N Lincoln Ave
Chicago, IL 60657-4201
Phone
(773) 665-9950
NPI assigned
Dec 29, 2022
Last updated
Apr 25, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 25, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X NU
Physical Therapist 225100000X 070027339 IL Primary

Addresses

Primary practice location

2869 N Lincoln Ave
Chicago, IL 60657-4201

Mailing address

1621 N Honore St Apt 3R
Chicago, IL 60622-1303
Phone (952) 484-3644

Other practice location 1

1640 W Roosevelt Rd
Chicago, IL 60608-1316
Phone (312) 413-0843

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230703002307 IL Practitioner - Physical Therapist in Private Practice 5193184513 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
University of Illinois College of Med (CHI/Peor/Rock/CHM-Urb), 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Genesis Orthopedics and Sports Medicine LLCGroup PAC ID 7618955808, 24 clinicians

Practice addresses (Care Compare)

2900 Foxfield Rd
Suite 102
St Charles, IL 60174-5799
Phone (630) 377-1188

Merit-based Incentive Payment System (MIPS)

Final score
93.28 of 100Reported as group
Quality
73.53
Promoting interoperability
100
Improvement activities
40
Cost
70.73

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
The Board of Trustees of the University of Illinois CurrentSince Oct 16, 2023 Accepting new patients
The Board of Trustees of the University of Illinois Physical Therapist CurrentSince Oct 16, 2023 Accepting new patients
Genesis Orthopedics & Sports Medicine LLC Physical Therapy CurrentSince Nov 18, 2024 Accepting new patients
The Board of Trustees of the University of Illinois Physical Therapy Current Accepting new patients
Genesis Orthopedics & Sports Medicine LLC CurrentSince Nov 18, 2024 Accepting new patients

Locations

1640 W Roosevelt Rd
Chicago, IL 60608
Phone (312) 413-1871

1640 W Roosevelt Rd
#727
Chicago, IL 60608
Phone (312) 413-1871

25 E Washington St
Ste 1310
Chicago, IL 60602
Phone (312) 855-1711

7732 Solution Ctr
Chicago, IL 60677
Phone (312) 355-4210

2425 W 22nd St
Ste 103
Oak Brook, IL 60523
Phone (630) 571-3333

2900 Foxfield Rd
Ste 102
St Charles, IL 60174
Phone (630) 209-1960

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1672272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745539200000",
    "number": "1073226510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1621 N HONORE ST APT 3R",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606221303",
            "telephone_number": "952-484-3644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2869 N LINCOLN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606574201",
            "telephone_number": "773-665-9950"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1640 W Roosevelt Rd",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606081316",
            "country_code": "US",
            "telephone_number": "312-413-0843",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREENWALT",
        "first_name": "DAKOTA",
        "middle_name": "JOHN",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-12-29",
        "last_updated": "2025-04-25",
        "certification_date": "2025-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070027339",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2025; 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.