Individual provider Active NPI

Marley Coughlin, PT

  • Physical Therapist
  • Tinley Park, IL
National Provider Identifier
1194493809
Registry record updated Jun 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070.026131 Issued in IL
Practice address
17495 La Grange Rd
Tinley Park, IL 60487-7581
Phone
(630) 967-2000
NPI assigned
Aug 30, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2022

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 070.026131 IL Primary

Addresses

Primary practice location

17495 La Grange Rd
Tinley Park, IL 60487-7581

Mailing address

1860 Paysphere Cir
Chicago, IL 60674-3807
Phone (630) 469-9200

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mcoughlin231654@direct.edward.org
Direct Messaging Address mcoughlin231654@dulyhealthandcare.direct-ci.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210913000444 IL Practitioner - Physical Therapist in Private Practice 0547666810 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Saint Louis University School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Illinois Bone and Joint Institute, LLCGroup PAC ID 6002814878, 603 clinicians

Practice addresses (Care Compare)

2101 Waukegan Rd
Bannockburn, IL 60015-1836

3000 N Halsted St
Chicago, IL 60657-9269

Merit-based Incentive Payment System (MIPS)

Final score
81.07 of 100Reported as group
Quality
76.54
Promoting interoperability
83
Improvement activities
40
Cost
74.52

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070.026131ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Illinois Bone and Joint Institute, LLC CurrentSince Jun 5, 2023 Accepting new patients
Illinois Bone and Joint Institute LLC CurrentSince Jun 5, 2023 Accepting new patients

Locations

2101 Waukegan Rd
Ste 110
Bannockburn, IL 60015
Phone (847) 914-9096

3000 N Halsted St
Ste 527
Chicago, IL 60657
Phone (773) 328-5930

2923 N California Ave
Ste 301
Chicago, IL 60618
Phone (773) 327-5639

5057 Paysphere Cir
Chicago, IL 60674

900 Rand Rd
Ste 300
Des Plaines, IL 60016
Phone (847) 324-3090

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.

NPI Registry JSON

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

{
    "created_epoch": "1630281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655769600000",
    "number": "1194493809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 PAYSPHERE CIR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606743807",
            "telephone_number": "630-469-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17495 LA GRANGE RD",
            "city": "TINLEY PARK",
            "state": "IL",
            "postal_code": "604877581",
            "telephone_number": "630-967-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COUGHLIN",
        "first_name": "MARLEY",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-30",
        "last_updated": "2022-06-21",
        "certification_date": "2022-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.026131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mcoughlin231654@direct.edward.org",
            "affiliation": "N",
            "address_1": "17495 La Grange Rd",
            "city": "Tinley Park",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604877581",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mcoughlin231654@dulyhealthandcare.direct-ci.com",
            "affiliation": "N",
            "address_1": "17495 La Grange Rd",
            "city": "Tinley Park",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604877581",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Tinley Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2022; 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.