Traci Kissinger, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070.020844 Issued in IL

Practice address

2200 Fort Jesse Rd
Suite 250
Normal, IL 61761-6286

Phone

(309) 888-9800

Fax

(309) 828-9700

NPI assigned

Sep 4, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Orthopedic and Shoulder Center S CGroup PAC ID 9537344403, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Orthopedic & Shoulder Center, S.C.

  • Orthopaedic Surgery Physician
  • Normal, IL
  • NPI 1437453073
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1409788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1409788800000",
    "number": "1134529555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 FORT JESSE RD",
            "address_2": "SUITE 250",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617616286",
            "telephone_number": "309-888-9800",
            "fax_number": "309-828-9700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 FORT JESSE RD",
            "address_2": "SUITE 250",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617616286",
            "telephone_number": "309-888-9800",
            "fax_number": "309-828-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISSINGER",
        "first_name": "TRACI",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-04",
        "last_updated": "2014-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.020844",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Keto, D.O.
• Todd Owen Kettering, D.O.
• Talha Mohammad Khan, MD
• Elkanah Israel Kindseth, PHARMD
• Shelly King, CCC-SLP
• Peter Klinkner, LCSW
• Mackenzie Knabe, CST
• Brenna Catherine Maxine Knott
• Kari And Edward Knowlton Green
• Jason Kobler, CRNA

• Physical Therapist in Normal, IL
• Providers in Normal, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2014; 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.