Individual provider Active NPI

Alfredo Sambrano Gargoles Jr., R.P.T

  • Physical Therapist
  • Orland Park, IL
National Provider Identifier
1295772002
Registry record updated May 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070-013947 Issued in IL
Practice address
17549 Mayher Dr
Orland Park, IL 60467-8559
Phone
(773) 882-2107
Fax
(708) 478-4530
NPI assigned
Jun 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2012

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 070-013947 IL Primary

Addresses

Primary practice location

17549 Mayher Dr
Orland Park, IL 60467-8559

Mailing address

17549 Mayher Dr
Orland Park, IL 60467-8559
Phone (773) 882-2107

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070914000663 IL Practitioner - Physical Therapist in Private Practice 4183718646 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Orland Park, IL 60467
Phone (773) 882-2107

16220 S Parker Rd
Homer Glen, IL 60491-9081
Phone (708) 301-6870

Merit-based Incentive Payment System (MIPS)

Final score
96.99 of 100Reported as individual
Quality
78.33
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070-013947ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Central Rehab Physical Therapy, Inc. Physical Therapist CurrentSince Jun 1, 2012 Accepting new patients
Central Rehab Inc. Physical Therapist Past Accepting new patients
Center for Disability Services Past Accepting new patients

Locations

16240 S Parker Rd
Lockport, IL 60491
Phone (708) 301-0571

16220 S Parker Rd
Lockport, IL 60491
Phone (708) 301-0571

Organizations & group practices 3

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": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1336089600000",
    "number": "1295772002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17549 MAYHER DR",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604678559",
            "telephone_number": "773-882-2107",
            "fax_number": "708-478-4530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17549 MAYHER DR",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604678559",
            "telephone_number": "773-882-2107",
            "fax_number": "708-478-4530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARGOLES",
        "first_name": "ALFREDO",
        "middle_name": "SAMBRANO",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "R.P.T",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-01",
        "last_updated": "2012-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070-013947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orland Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2012; 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.