Active NPI
Paul G Sullivan, PT
- Physical Therapist
- New Lenox, IL
National Provider Identifier
1154428803
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070010530
- Practice address
- 1938 E Lincoln Hwy
Suite 111
New Lenox, IL 60451-3810 - Phone
- (815) 485-2916
- Fax
- (815) 485-2918
- NPI assigned
- Sep 17, 2006
- Sex
- Male
- 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 | 070010530 | IL | Primary |
Addresses
Primary practice location
1938 E Lincoln Hwy
Suite 111
New Lenox, IL 60451-3810
Mailing address
600 Oakmont LN Ste 600C
Westmont, IL 60559-5548
Phone (630) 575-6200
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CJ8115 | Other | IL | R.R. MEDICARE GRP# |
| 1619908 | Other | IL | BCBS IL GROUP NUMBER |
| 1623066 | Other | IL | BCBS PROVIDER # |
| 367885100 | Other | IL | US DEPT OF LABOR |
| CJ4383 | Other | IL | R.R. MEDICARE GRP# |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Occusport Services Inc. | Physical Therapist | Past | Accepting new patients |
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.
-
- Physical Therapist
- Oak Brook, IL
- NPI 1821085028
-
- Physical Therapist
- Lockport, IL
- NPI 1952350886
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525996800000",
"number": "1154428803",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "600 OAKMONT LN STE 600C",
"city": "WESTMONT",
"state": "IL",
"postal_code": "605595548",
"telephone_number": "630-575-6200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1938 E LINCOLN HWY",
"address_2": "SUITE 111",
"city": "NEW LENOX",
"state": "IL",
"postal_code": "604513810",
"telephone_number": "815-485-2916",
"fax_number": "815-485-2918"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SULLIVAN",
"first_name": "PAUL",
"middle_name": "G",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-17",
"last_updated": "2018-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070010530",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "R.R. MEDICARE GRP#",
"identifier": "CJ8115",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS IL GROUP NUMBER",
"identifier": "1619908",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER #",
"identifier": "1623066",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "US DEPT OF LABOR",
"identifier": "367885100",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "R.R. MEDICARE GRP#",
"identifier": "CJ4383",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in New Lenox, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 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.