Individual provider Active NPI

Deja Miller, PT, DPT

  • Physical Therapist
  • Chicago, IL
National Provider Identifier
1194458067
Registry record updated Feb 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070026624 Issued in IL
Practice address
1103 S State St Ste 300
Chicago, IL 60605-2775
Phone
(312) 877-5101
Fax
(312) 877-5906
NPI assigned
Jul 7, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 3, 2023

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 070026624 IL Primary

Addresses

Primary practice location

1103 S State St Ste 300
Chicago, IL 60605-2775

Mailing address

PO Box 220
Westmont, IL 60559-0220
Phone (708) 590-6663

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220725002919 IL Practitioner - Physical Therapist in Private Practice 2769863596 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Impact Physical Therapy, LLCGroup PAC ID 2466998398, 43 clinicians

Practice addresses (Care Compare)

1103 S State St
Suite 300
Chicago, IL 60605-2775
Phone (312) 877-5101

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Athletic and Therapeutic Institute of Naperville LLC Physical Therapist CurrentSince Jul 11, 2022 Accepting new patients
Ipt Management Services, Inc. Physical Therapist CurrentSince Feb 1, 2023 Accepting new patients
Athletic and Therapeutic Institute of Naperville, LLC CurrentSince Jul 11, 2022 Accepting new patients
Impact Physical Therapy, LLC Physical Therapist CurrentSince Aug 1, 2024 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

1103 S State St
Ste 300
Chicago, IL 60605
Phone (312) 877-5101

4947 Paysphere Cir
Chicago, IL 60674
Phone (630) 783-2001

800 Des Plaines Ave
Forest Park, IL 60130
Phone (708) 366-2442

2325 W Monroe St
Springfield, IL 62704
Phone (217) 241-0270

967 N Green Bay Rd
Waukegan, IL 60085
Phone (224) 321-5237

109 W Geneva Rd
Wheaton, IL 60187
Phone (630) 784-3251

0S050 Winfield Rd
Ste 120
Winfield, IL 60190
Phone (630) 653-4743

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1657152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675382400000",
    "number": "1194458067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 220",
            "city": "WESTMONT",
            "state": "IL",
            "postal_code": "605590220",
            "telephone_number": "708-590-6663",
            "fax_number": "708-469-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1103 S STATE ST STE 300",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606052775",
            "telephone_number": "312-877-5101",
            "fax_number": "312-877-5906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILLER",
        "first_name": "DEJA",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-07",
        "last_updated": "2023-02-03",
        "certification_date": "2023-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070026624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Feb 3, 2023; 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.