Individual provider Active NPI

Joseph Virgilio B Pablo, DPT

  • Physical Therapist
  • Chicago, IL
National Provider Identifier
1124630140
Registry record updated Oct 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070.025376 Issued in IL
Practice address
1611 W Harrison St Ste 107
Chicago, IL 60612-4861
Phone
(877) 632-6637
Fax
(708) 409-5179
NPI assigned
Aug 20, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2024

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 070.025376 IL Primary

Addresses

Primary practice location

1611 W Harrison St Ste 107
Chicago, IL 60612-4861

Mailing address

1611 W Harrison St Ste 107
Chicago, IL 60612-4861
Phone (877) 632-6637

Other practice location 1

200 Lindow Ln Ste E
Marengo, IL 60152-9498
Phone (815) 568-8878

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, WY, WA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20201112000399 IL Practitioner - Physical Therapist in Private Practice 9537579099 Reassigns benefits to 1 organization
I20240412001567 WY Practitioner - Physical Therapist in Private Practice 9537579099 Reassigns benefits to 1 organization
I20240826002764 WA Practitioner - Physical Therapist in Private Practice 9537579099 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orthomidwest, PLLCGroup PAC ID 0749183713, 531 clinicians

Practice addresses (Care Compare)

1611 W Harrison St
Suite 107
Chicago, IL 60612-4861
Phone (877) 632-6637

Merit-based Incentive Payment System (MIPS)

Final score
84.02 of 100Reported as group
Quality
68.63
Promoting interoperability
100
Improvement activities
40
Cost
78.11

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070.025376ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Kitsap Physical Therapy and Sports Clinic PS Inc Physical Therapist CurrentSince Jul 15, 2024 Accepting new patients
Kitsap Physical Therapy and Sports Clinic PS Inc Physical Therapist CurrentSince Jul 15, 2024 Accepting new patients
William H and Carrie Gottsche Foundation CurrentSince Mar 11, 2024 Accepting new patients
Orthomidwest, PLLC Physical Therapist CurrentSince Oct 28, 2024 Accepting new patients
Orthomidwest, PLLC CurrentSince Oct 28, 2024 Accepting new patients
Holistic Pain Management of Wyoming, LLC Past Accepting new patients

Locations

650 S Randall Rd
Algonquin, IL 60102
Phone (779) 771-7000

770 Beloit Rd
Belvidere, IL 61008
Phone (815) 847-7060

1611 W Harrison St
Ste 107
Chicago, IL 60612
Phone (312) 432-2513

19505 7th Ave NE
Poulsbo, WA 98370
Phone (360) 598-3764

2400 NW Myhre Rd
Ste 101
Silverdale, WA 98383
Phone (360) 598-3764

2400 NW Myhre Rd
Ste 102
Silverdale, WA 98383
Phone (360) 598-3764

639 W Coulter Ave
Powell, WY 82435
Phone (307) 754-9262

Interoperability endpoints

  • Direct secure messaging: joseph.pablo.1@12576.direct.athenahealth.com

Organizations & group practices 6

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": "1597881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729641600000",
    "number": "1124630140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1611 W HARRISON ST STE 107",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124861",
            "telephone_number": "877-632-6637",
            "fax_number": "708-409-5179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1611 W HARRISON ST STE 107",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606124861",
            "telephone_number": "877-632-6637",
            "fax_number": "708-409-5179"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Lindow Ln Ste E",
            "address_purpose": "LOCATION",
            "city": "Marengo",
            "state": "IL",
            "postal_code": "601529498",
            "country_code": "US",
            "telephone_number": "815-568-8878",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PABLO",
        "first_name": "JOSEPH",
        "middle_name": "VIRGILIO B",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-20",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.025376",
            "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 Oct 23, 2024; 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.