NPIMap

Organization Active NPI

Revolution PTWL LLC

Doing business as Revolution Physical Therapy Weight Loss

  • Physical Therapist
  • Chicago, IL
National Provider Identifier
1164766606
Registry record updated Jun 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
REVOLUTION PTWL LLC
Doing business as
Revolution Physical Therapy Weight Loss
Practice address
845 N Michigan Ave
Suite 973W
Chicago, IL 60611
Phone
(312) 878-8800
Fax
(312) 448-9978
NPI assigned
Nov 21, 2012
Last updated
Jun 6, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2018

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

Authorized official

Name
Mr. Randolph FrieserNPI 1366466252
Title
President
Phone
(312) 878-8800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Registered DietitianGroup: 193200000X MULTI-SPECIALTY GROUP 133V00000X
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

845 N Michigan Ave
Suite 973W
Chicago, IL 60611

Mailing address

845 N Michigan Ave
Suite 973W
Chicago, IL 60611-2252
Phone (312) 878-8800

Other names 1

  • Revolution Physical Therapy Weight Loss Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140123001222 IL Part B Supplier - Clinic/Group Practice 7719115617 Receives reassigned benefits from 75 practitioners
Practice locations: Westmont, IL; Glenview, IL; Glen Ellyn, IL; Chicago, IL

National Provider Directory

National Provider Directory

Locations

182 W Lake St
Lbby 2
Chicago, IL 60601

2641 W Harrison St
Chicago, IL 60612
Phone (708) 264-1919

3168 N Broadway St
Chicago, IL 60657
Phone (312) 586-7977

3418 S Halsted St
Chicago, IL 60608
Phone (773) 337-7627

4851 N Milwaukee Ave
Chicago, IL 60630
Phone (773) 241-7350

845 N Michigan Ave
#973
Chicago, IL 60611

845 N Michigan Ave
Ste 973
Chicago, IL 60611
Phone (312) 651-6255

845 N Michigan Ave
Ste 973W
Chicago, IL 60611
Phone (312) 651-6255

720 Roosevelt Rd
Glen Ellyn, IL 60137
Phone (630) 730-8456

14400 John Humphrey Dr
Orland Park, IL 60462
Phone (708) 226-1360

Practitioners & affiliated clinicians

Practitioners 88

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 88

NPI Registry JSON

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

{
    "created_epoch": "1353456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528243200000",
    "number": "1164766606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "845 N MICHIGAN AVE",
            "address_2": "SUITE 973W",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112252",
            "telephone_number": "312-878-8800",
            "fax_number": "312-448-9978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "845 N MICHIGAN AVE",
            "address_2": "SUITE 973W",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60611",
            "telephone_number": "312-878-8800",
            "fax_number": "312-448-9978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVOLUTION PTWL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-11-21",
        "last_updated": "2018-06-06",
        "status": "A",
        "authorized_official_last_name": "FRIESER",
        "authorized_official_first_name": "RANDOLPH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-878-8800",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Revolution Physical Therapy Weight Loss",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Revolution Physical Therapy Weight Loss",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 6, 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.

Verify at the official NPI Registry.