Individual provider Active NPI

Kimberly Painter, PT, DPT

  • Physical Therapist
  • Champaign, IL
National Provider Identifier
1093259525
Registry record updated Dec 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070.022757 Issued in IL
Practice address
2906 Crossing CT
Champaign, IL 61822-6163
Phone
(217) 398-9800
Fax
(217) 366-0037
NPI assigned
Dec 19, 2016
Last updated
Dec 19, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2016

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 070.022757 IL Primary

Addresses

Primary practice location

2906 Crossing CT
Champaign, IL 61822-6163

Mailing address

2906 Crossing CT
Champaign, IL 61822-6163
Phone (217) 398-9800

Other identifiers 1

IdentifierTypeStateIssuer
070.022757OtherILLICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170208000979 IL Practitioner - Physical Therapist in Private Practice 1850674391 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5255 E Maryland St
Decatur, IL 62521-9705
Phone (217) 864-1264

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070.022757ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Pathology, PLLC CurrentSince Mar 15, 2021 Accepting new patients
Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Path Physical Therapist CurrentSince Mar 15, 2021 Accepting new patients

Locations

2110 Fox Dr
Ste D
Champaign, IL 61820
Phone (217) 398-9800

2906 Crossing Ct
Champaign, IL 61822
Phone (217) 356-6543

204 E Washington St
Clinton, IL 61727
Phone (217) 570-0225

5255 E Maryland St
Decatur, IL 62521
Phone (217) 864-1264

1377 Motor Pkwy
Ste 307
Ronkonkoma, NY 11749

Organizations & group practices 2

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": "1482105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482105600000",
    "number": "1093259525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2906 CROSSING CT",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618226163",
            "telephone_number": "217-398-9800",
            "fax_number": "217-366-0037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2906 CROSSING CT",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618226163",
            "telephone_number": "217-398-9800",
            "fax_number": "217-366-0037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAINTER",
        "first_name": "KIMBERLY",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-12-19",
        "last_updated": "2016-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.022757",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "070.022757",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Champaign, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2016; 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.