NPIMap

Organization Active NPI

Northern Illinois University

Doing business as NIU Physical Therapy Clinic

  • Physical Therapy Clinic/Center
  • Dekalb, IL
National Provider Identifier
1194991216
Registry record updated Oct 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy Clinic/CenterTaxonomy code 261QP2000X
License
070012170 Issued in IL
Legal business name
NORTHERN ILLINOIS UNIVERSITY
Doing business as
NIU Physical Therapy Clinic
Practice address
3100 Sycamore Rd
Dekalb, IL 60115-9621
Phone
(815) 752-2675
Fax
(815) 753-6169
NPI assigned
May 8, 2008
Last updated
Oct 17, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2024

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

Authorized official

Name
Carissa Nicole Callahan
Title
Assistant to the Dean
Phone
(815) 753-6161

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Clinic/Center 261QP2000X 070012170 IL Primary

Addresses

Primary practice location

3100 Sycamore Rd
Dekalb, IL 60115-9621

Mailing address

3100 Sycamore Rd
Dekalb, IL 60115-9621
Phone (815) 752-2675

Other names 1

  • NIU Physical Therapy Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050104000460 IL Part B Supplier - Clinic/Group Practice 2860440195 Receives reassigned benefits from 17 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Dekalb, IL

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
Psychological Services6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1210204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729123200000",
    "number": "1194991216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 SYCAMORE RD",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601159621",
            "telephone_number": "815-752-2675",
            "fax_number": "815-753-6169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 SYCAMORE RD",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601159621",
            "telephone_number": "815-752-2675",
            "fax_number": "815-753-6169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN ILLINOIS UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-08",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A",
        "authorized_official_last_name": "CALLAHAN",
        "authorized_official_first_name": "CARISSA",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "ASSISTANT TO THE DEAN",
        "authorized_official_telephone_number": "815-753-6161"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "IL",
            "license": "070012170",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NIU Physical Therapy Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dekalb, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; 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.