Individual provider Active NPI

Susan Christine Portner, RPT

  • Physical Therapist
  • Mount Vernon, IL
National Provider Identifier
1124071915
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070-005588 Issued in IL
Practice address
4121 Veterans Memorial Dr
Mount Vernon, IL 62864-6262
Phone
(618) 242-8887
Fax
(618) 244-5537
NPI assigned
May 19, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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 070-005588 IL Primary

Addresses

Primary practice location

4121 Veterans Memorial Dr
Mount Vernon, IL 62864-6262

Mailing address

4121 Veterans Memorial Dr
Mount Vernon, IL 62864-6262
Phone (618) 242-8887

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050725000397 IL Practitioner - Physical Therapist in Private Practice 6305873043 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthopaedic Center of Southern Illinois, LTDGroup PAC ID 6901705441, 18 clinicians

Practice addresses (Care Compare)

4121 Veterans Memorial Dr
Mount Vernon, IL 62864-6262
Phone (618) 242-3778

Merit-based Incentive Payment System (MIPS)

Final score
79.43 of 100Reported as group
Quality
59.68
Promoting interoperability
92
Improvement activities
40
Cost
72.02

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070-005588ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopaedic Center of Southern Illinois, LTD. CurrentSince Jun 6, 2005 Accepting new patients
Orthopaedic Center of Southern Illinois, LTD. Current Accepting new patients

Locations

4121 Veterans Memorial Dr
Mount Vernon, IL 62864
Phone (618) 242-8887

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1124071915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4121 VETERANS MEMORIAL DR",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646262",
            "telephone_number": "618-242-8887",
            "fax_number": "618-244-5537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4121 VETERANS MEMORIAL DR",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628646262",
            "telephone_number": "618-242-8887",
            "fax_number": "618-244-5537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PORTNER",
        "first_name": "SUSAN",
        "middle_name": "CHRISTINE",
        "name_prefix": "Mrs.",
        "credential": "RPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-19",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070-005588",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.