Individual provider Active NPI

Beth M Pacocha Auer, PT, MPT

  • Physical Therapist
  • Fairview Heights, IL
National Provider Identifier
1366570947
Registry record updated Feb 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070014335 Issued in IL
Practice address
525 Lincoln Hwy
Suite 28
Fairview Heights, IL 62208-2142
Phone
(618) 622-5180
Fax
(618) 622-5169
NPI assigned
Mar 2, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 2006033635 MO
Physical Therapist 225100000X 070014335 IL Primary

Addresses

Primary practice location

525 Lincoln Hwy
Suite 28
Fairview Heights, IL 62208-2142

Mailing address

1377 Motor Pkwy
Ste 307
Islandia, NY 11749-5258
Phone (631) 580-5200

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050513000498 IL Practitioner - Physical Therapist in Private Practice 7517908155 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rci (WRS) LLCGroup PAC ID 5092624510, 325 clinicians

Practice addresses (Care Compare)

17 W Butterfield Rd
Suite 580
Oakbrook Terrace, IL 60181-4036
Phone (630) 889-8125

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2006033635MOMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Pathology, PLLC CurrentSince Feb 20, 2020 Accepting new patients
Rci (WRS), LLC. Physical Therapist Current Accepting new patients
Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Path Physical Therapist CurrentSince Feb 20, 2020 Accepting new patients
Rci (WRS), LLC CurrentSince Dec 11, 2020 Accepting new patients
Rci (WRS), LLC. CurrentSince Dec 11, 2020 Accepting new patients
Rehab Missouri, LLC. Past Accepting new patients

Locations

204 E Washington St
Clinton, IL 61727
Phone (217) 570-0225

2777 Maple Ave
Lisle, IL 60532
Phone (630) 326-8810

9000 W College Pkwy
Palos Hills, IL 60465
Phone (618) 529-3201

826 W Touhy Ave
Park Ridge, IL 60068
Phone (847) 720-4165

1377 Motor Pkwy
Ste 307
Ronkonkoma, NY 11749

Organizations & group practices 6

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": "1172793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582156800000",
    "number": "1366570947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1377 MOTOR PKWY",
            "address_2": "STE 307",
            "city": "ISLANDIA",
            "state": "NY",
            "postal_code": "117495258",
            "telephone_number": "631-580-5200",
            "fax_number": "631-580-5222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 LINCOLN HWY",
            "address_2": "SUITE 28",
            "city": "FAIRVIEW HEIGHTS",
            "state": "IL",
            "postal_code": "622082142",
            "telephone_number": "618-622-5180",
            "fax_number": "618-622-5169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACOCHA AUER",
        "first_name": "BETH",
        "middle_name": "M",
        "credential": "PT, MPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-02",
        "last_updated": "2020-02-20",
        "certification_date": "2020-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MO",
            "license": "2006033635",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070014335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairview Heights, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2020; 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.