Active NPI
Ellen Humphrey, P.T.
- Physical Therapist
- Lake Bluff, IL
National Provider Identifier
1114256997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 101 Waukegan Rd Ste 1100
Lake Bluff, IL 60044-3012 - Phone
- (847) 247-2402
- Fax
- (847) 247-2405
- NPI assigned
- Dec 8, 2009
- Last updated
- Feb 14, 2018
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | Primary |
Addresses
Primary practice location
101 Waukegan Rd Ste 1100
Lake Bluff, IL 60044-3012
Mailing address
900 Rand Rd Ste 300
Des Plaines, IL 60016-2359
Phone (847) 324-3976
Other practice location 1
1200 N Westmoreland Rd
Lake Forest, IL 60045-1601
Phone (847) 535-7551
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161011001145 | IL | Practitioner - Physical Therapist in Private Practice | 0749578516 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1260230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1518566400000",
"number": "1114256997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "900 RAND RD STE 300",
"city": "DES PLAINES",
"state": "IL",
"postal_code": "600162359",
"telephone_number": "847-324-3976",
"fax_number": "847-929-1154"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 WAUKEGAN RD STE 1100",
"city": "LAKE BLUFF",
"state": "IL",
"postal_code": "600443012",
"telephone_number": "847-247-2402",
"fax_number": "847-247-2405"
}
],
"practiceLocations": [
{
"address_1": "1200 N Westmoreland Rd",
"address_purpose": "LOCATION",
"city": "Lake Forest",
"state": "IL",
"postal_code": "600451601",
"country_code": "US",
"telephone_number": "847-535-7551",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HUMPHREY",
"first_name": "ELLEN",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-12-08",
"last_updated": "2018-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Bluff, IL
- Madison Hoover
- Lauren Howard, M.A
- Huggins Chiropractic and Acupunctureclinicltd (Huggins integrative health)
- Caryllon Cummings Huggins, DC,DACBN,CCN
- Teanna Huley
- Robert Iliff, D.C.
- Illinois Bone and Joint Institue, LLC
- Illinois Bone and Joint Institute, LLC
- Illinois Bone and Joint Institute, LLC
- Illinois Bone and Joint Institute, LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.