Brent Wilson, DPT

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

070.025455 Issued in IL

Practice address

1640 W Roosevelt Rd
Chicago, IL 60608-1316

Phone

(312) 355-8305

Fax

(312) 413-8333

NPI assigned

Dec 17, 2020

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

Enrolled in IL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Elmhurst Olympic Service CorporationGroup PAC ID 1052408747, 6 clinicians

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 and National Provider Directory roles.

• Elmhurst Olympic Service Corporation

  • Chiropractor
  • Elmhurst, IL
  • NPI 1174696959
  Medicare reassignment Care Compare group NPD
• Carol Stream Service Corporation

  • Chiropractor
  • Bartlett, IL
  • NPI 1679641823
  Medicare reassignment NPD
• The Board of Trustees of the University of Illinois

  • Anatomic Pathology Physician
  • Chicago, IL
  • NPI 1386863819
  Medicare reassignment NPD
• Sycamore Service Corporation

  • Chiropractor
  • Sycamore, IL
  • NPI 1841493111
  NPD
• The Board of Trustees of the University of Illinois

  • Occupational Medicine Physician
  • Chicago, IL
  • NPI 1043727571
  NPD
• The Board of Trustees of the University of Illinois

  • Clinic/Center
  • Chicago, IL
  • NPI 1801920186
  NPD

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

{
    "created_epoch": "1608163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610323200000",
    "number": "1346836814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 W ROOSEVELT RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606081316",
            "telephone_number": "312-355-8305",
            "fax_number": "312-413-8333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 W ROOSEVELT RD",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606081316",
            "telephone_number": "312-355-8305",
            "fax_number": "312-413-8333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "BRENT",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-17",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "IL",
            "license": "070.025455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arianne Wilson, MD
• Ashley Wilson, LCSW
• Bianca Wilson, MD
• Brandy L Wilson
• Breiona Wilson
• Brianna Wilson
• Brittany Wilson, LPC
• Candace Wilson, MD
• Carl L Wilson, LPC
• Caroline Corey Wilson, QMHP

• Orthopedic Physical Therapist in Chicago, IL
• Providers in Chicago, IL by specialty
• Orthopedic Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2021; 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.