NPIMap

Organization Active NPI

Memorial Industrial Rehabilitation of Jacksonville

  • Physical Therapy Assistant
  • Jacksonville, IL
National Provider Identifier
1093775561
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
Legal business name
MEMORIAL INDUSTRIAL REHABILITATION OF JACKSONVILLE
Practice address
901 W Morton Ave
Suite 16a
Jacksonville, IL 62650-3146
Phone
(217) 245-4640
Fax
(217) 245-4642
NPI assigned
Mar 27, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Authorized official

Name
Robert T Clarke
Title
President and Ceo
Phone
(217) 788-3340

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapy Assistant 224Z00000X NU
Physical Therapist 225100000X NU
Physical Therapy Assistant 225200000X NU Primary
Occupational Therapist 225X00000X NU

Addresses

Primary practice location

901 W Morton Ave
Suite 16a
Jacksonville, IL 62650-3146

Mailing address

901 W Morton Ave
Suite 16a
Jacksonville, IL 62650-3146
Phone (217) 245-4640

Other identifiers 1

IdentifierTypeStateIssuer
06932016OtherBCBS GROUP NUMBER

National Provider Directory

National Provider Directory

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": "1143417600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1093775561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 W MORTON AVE",
            "address_2": "SUITE 16A",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626503146",
            "telephone_number": "217-245-4640",
            "fax_number": "217-245-4642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 W MORTON AVE",
            "address_2": "SUITE 16A",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626503146",
            "telephone_number": "217-245-4640",
            "fax_number": "217-245-4642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL INDUSTRIAL REHABILITATION OF JACKSONVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-27",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "CLARKE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "217-788-3340"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "06932016",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.