Ian B Petersen, ATC-L

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

345 Taft Road
South Holland, IL 60473

Phone

(708) 596-0107

Fax

(708) 671-0767

NPI assigned

Feb 13, 2006

Last updated

Nov 26, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• WCS Occupational Rehabilitation and Sports Medicine, Inc.

  • Physical Therapist
  • South Holland, IL
  • NPI 1578610515
  NPD (past)

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

{
    "created_epoch": "1139788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196035200000",
    "number": "1255305850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14720 CENTRAL AVE",
            "city": "OAK FOREST",
            "state": "IL",
            "postal_code": "604521268",
            "telephone_number": "219-617-5253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 TAFT ROAD",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "60473",
            "telephone_number": "708-596-0107",
            "fax_number": "708-671-0767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "IAN",
        "middle_name": "B",
        "credential": "ATC-L",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-13",
        "last_updated": "2007-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Angela Perry, M.D.
• Jasa Perry, LCPC
• Alexander Perteete
• Peter H. Neale SC
• Peter M. Jurkash, D.D.S.,P.C.
• Pioneer Concepts Inc (Holland Terrace)
• Robert Poepsel
• Cathy J Postma, OTR/L
• Prairie Oasis, LLC (Prairie Oasis)
• Premium PT Solutions LLC

• Athletic Trainer in South Holland, IL
• Providers in South Holland, IL by specialty
• Athletic Trainer in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.