Individual provider Active NPI

Gil V Agoncillo, PT

  • Physical Therapist
  • Skokie, IL
National Provider Identifier
1174677736
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
9416 Skokie Blvd
Skokie, IL 60077-1311
Phone
(847) 673-4800
Fax
(847) 673-9322
NPI assigned
Jan 22, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 IL Primary

Addresses

Primary practice location

9416 Skokie Blvd
Skokie, IL 60077-1311

Mailing address

9416 Skokie Blvd
Skokie, IL 60077-1311
Phone (847) 673-4800

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070307000160 IL Practitioner - Physical Therapist in Private Practice 2062515380 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070.008730ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Absolute Medical & Diagnostic Center, SC CurrentSince Sep 6, 2022 Accepting new patients
Advanced Care Physical Therapy Inc Physical Therapist Past Accepting new patients
Noel Castelino SC Past Accepting new patients

Locations

1655 N Arlington Heights Rd
Ste 101W
Arlington Heights, IL 60004
Phone (847) 305-3610

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1174677736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9416 SKOKIE BLVD",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600771311",
            "telephone_number": "847-673-4800",
            "fax_number": "847-673-9322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9416 SKOKIE BLVD",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600771311",
            "telephone_number": "847-673-4800",
            "fax_number": "847-673-9322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGONCILLO",
        "first_name": "GIL",
        "middle_name": "V",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Skokie, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.