Richard Warren Kruckeberg, P.T., O.C.S., C.H.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070.002766 Issued in IL

Practice address

100 Professional PLZ
Mattoon, IL 61938-9252

Phone

(217) 345-1245

Fax

(217) 345-1253

NPI assigned

Mar 9, 2007

Last updated

Sep 19, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 1978

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Central Illinois Physical Therapy Professionals, LTD

  • Physical Therapist
  • Sullivan, IL
  • NPI 1124246939
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1173398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316390400000",
    "number": "1245362920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 PROFESSIONAL PLZ",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619389252",
            "telephone_number": "217-345-1245",
            "fax_number": "217-345-1253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 PROFESSIONAL PLZ",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619389252",
            "telephone_number": "217-345-1245",
            "fax_number": "217-345-1253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUCKEBERG",
        "first_name": "RICHARD",
        "middle_name": "WARREN",
        "name_prefix": "Mr.",
        "credential": "P.T., O.C.S., C.H.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-09",
        "last_updated": "2011-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.002766",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Kohlmann, M.D.
• Elizabeth Kopp
• Emily J Kramer
• Jessica Taylee Kramer, CNA
• Marlene Kremer, M.D.
• Megan Kuhn, M.S.
• Frances Catherine Kuhns, PHARM.D.
• Gaylin Lack, M.D.
• Haylie Nicole Lading, DPT
• Joanna Laffey, RDH PHDH

• Physical Therapist in Mattoon, IL
• Providers in Mattoon, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2011; 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.