NPIMap

Organization Active NPI

Independence Health & Therapy

  • Public Health or Welfare Agency
  • Woodstock, IL
National Provider Identifier
1184744625
Registry record updated Nov 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
Legal business name
INDEPENDENCE HEALTH & THERAPY
Practice address
708 Washington St.
Woodstock, IL 60098
Phone
(815) 338-1707
Fax
(815) 338-1786
NPI assigned
Mar 29, 2007
Organization subpart
Yes
Parent organization
INDEPENDENCE HEALTH & THERAPYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 19, 2018

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

Authorized official

Name
Mrs. Kimberly Larson, R.N.
Title
Executive Director
Phone
(815) 333-8657

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225XP0200X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X
Public Health or Welfare Agency 251K00000X 1747736 IL
Public Health or Welfare Agency 251K00000X Primary
Rehabilitation Clinic/Center 261QR0400X 1747736 IL

Addresses

Primary practice location

708 Washington St.
Woodstock, IL 60098

Mailing address

2028 N. Seminary Ave.
Woodstock, IL 60098
Phone (815) 338-3590

Other identifiers 2

IdentifierTypeStateIssuer
362264411001MedicaidIL
05615103OtherILBLUE CROSS BLUE SHIELD

Other names 1

  • Adult & Child Rehabilitation Center for McHenry County Illinois Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040129000421 IL Part B Supplier - Clinic/Group Practice 2062315849 Receives reassigned benefits from 11 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Woodstock, IL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Family Alliance Inc4 organizations share this tax ID, including this one
Part of
Family Alliance Inc

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

12555 Farm Hill Dr
#800
Huntley, IL 60142
Phone (224) 654-6300

2028 N Seminary Ave
Woodstock, IL 60098
Phone (815) 333-8650

Practitioners & affiliated clinicians

Practitioners 11

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": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542585600000",
    "number": "1184744625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2028 N. SEMINARY AVE.",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "60098",
            "telephone_number": "815-338-3590",
            "fax_number": "815-337-4406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "708 WASHINGTON ST.",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "60098",
            "telephone_number": "815-338-1707",
            "fax_number": "815-338-1786"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE HEALTH & THERAPY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INDEPENDENCE HEALTH & THERAPY",
        "enumeration_date": "2007-03-29",
        "last_updated": "2018-11-19",
        "status": "A",
        "authorized_official_last_name": "LARSON",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "815-333-8657",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.N."
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "IL",
            "license": "1747736",
            "primary": false
        },
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "IL",
            "license": "1747736",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "362264411001",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "05615103",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Adult & Child Rehabilitation Center for McHenry County Illinois",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Woodstock, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 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.