NPIMap

Organization Active NPI

Pure Health Physical Medicine, LLC

  • Family Medicine Physician
  • Aurora, IL
National Provider Identifier
1134466162
Registry record updated May 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036099986 Issued in IL
Legal business name
PURE HEALTH PHYSICAL MEDICINE, LLC
Practice address
2116 W Galena Blvd
Suite 112
Aurora, IL 60506-3533
Phone
(630) 897-1895
NPI assigned
Jan 10, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 17, 2024

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

Authorized official

Name
Kenneth Olson, D.C.
Title
Owner
Phone
(630) 897-1895

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 038008765 IL
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 038011191 IL
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 038011696 IL
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 036099986 IL Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X 209010369 IL

Addresses

Primary practice location

2116 W Galena Blvd
Suite 112
Aurora, IL 60506-3533

Mailing address

2116 W Galena Blvd
Suite 112
Aurora, IL 60506-3533
Phone (630) 897-1895

Other identifiers 1

IdentifierTypeStateIssuer
IL8252OtherILMEDICARE PTAN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130522000117 IL Part B Supplier - Clinic/Group Practice 8426296005 Receives reassigned benefits from 5 practitioners
Practice locations: Aurora, IL
O20220512002059 IL DME Supplier - Physician - Family PracticeDME Supplier - Physician - Chiropractic 8426296005 Practice locations: Aurora, IL

National Provider Directory

National Provider Directory

Locations

2116 W Galena Blvd
Aurora, IL 60506

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1357776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715904000000",
    "number": "1134466162",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2116 W GALENA BLVD",
            "address_2": "SUITE 112",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605063533",
            "telephone_number": "630-897-1895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2116 W GALENA BLVD",
            "address_2": "SUITE 112",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605063533",
            "telephone_number": "630-897-1895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PURE HEALTH PHYSICAL MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-10",
        "last_updated": "2024-05-17",
        "certification_date": "2024-05-17",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-897-1895",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038008765",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038011191",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038011696",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036099986",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209010369",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "IL8252",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Aurora, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2024; 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.

Verify at the official NPI Registry.