Active NPI
Jenine K Tubergen, OTR/L
- Occupational Therapist
- Chicago, IL
National Provider Identifier
1104090919
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- Practice address
- 345 E Superior St
Chicago, IL 60611-2654 - Phone
- (312) 238-1228
- NPI assigned
- Apr 14, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | IL | Primary |
Addresses
Primary practice location
345 E Superior St
Chicago, IL 60611-2654
Mailing address
1943 Greenwood Ave
Wilmette, IL 60091-1437
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 2000
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1520 Elmwood Ave
Wilmette, IL 60091-1653
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 056.006095 | IL | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Illinois Home Therapy LLC | Occupational Therapist | Current | Accepting new patients |
Organizations & group practices 1
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": "1208131200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1208131200000",
"number": "1104090919",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1943 GREENWOOD AVE",
"city": "WILMETTE",
"state": "IL",
"postal_code": "600911437"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "345 E SUPERIOR ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606112654",
"telephone_number": "312-238-1228"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TUBERGEN",
"first_name": "JENINE",
"middle_name": "K",
"credential": "OTR/L",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-04-14",
"last_updated": "2008-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "IL",
"license": null,
"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 14, 2008; 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.