Gordon D Holden, PT
Individual provider Active NPI Physical Therapist · Mounds, IL
NPI 1316038938 · NPPES record last updated Mar 13, 2013
Key facts
- NPI
- 1316038938
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 070-007952 (IL)
- Practice address
- 120 N Front St
Cairo Rehab & Fit for Golf Inc
Mounds, IL 62964-1022 - Phone
- (304) 363-7000
- Fax
- (304) 366-7413
- NPI assigned
- Sep 27, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Saint Louis University School of Medicine, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
120 N Front St
Mounds, IL 62964-1022
Phone (618) 745-6300
Merit-based Incentive Payment System (MIPS)
- Final score
- 95 of 100
- Quality
- 80
- Improvement activities
- 40
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040614001557 | IL | Practitioner - Physical Therapist in Private Practice | 4082698550 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070-007952 | IL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Diversified Rehab Services, LLC | Physical Therapist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070-007952 | IL | Yes |
Addresses
Primary practice location
120 N Front St
Cairo Rehab & Fit for Golf Inc
Mounds, IL 62964-1022
Mailing address
120 N Front St
Cairo Rehab & Fit for Golf Inc
Mounds, IL 62964-1022
Phone (304) 363-7000
Other providers in Mounds, IL
- County of Pulaski
- Delta Center, Inc
- Diversified Rehab Services, LLC
- Dixon Chiropractic Center, PC
- Dewey G Dixon Jr.
- Integrated Family Health LLC
- Meridian Cusd #101
- Elly Nelson
All providers in Mounds, IL · Physical Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 13, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.