NPIMap

Organization Active NPI

Advance Physical Therapy & Sports Medicine of Chatham LLC

  • Physical Therapist
  • Chatham, IL
National Provider Identifier
1376706234
Registry record updated Jan 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
ADVANCE PHYSICAL THERAPY & SPORTS MEDICINE OF CHATHAM LLC
Practice address
1089 Jason PL
Chatham, IL 62629
Phone
(217) 222-6800
Fax
(217) 222-0037
NPI assigned
Jul 9, 2008
Last updated
Jan 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2024

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

Authorized official

Name
Gregory Reis, P.T.NPI 1972519171
Title
Partner
Phone
(217) 222-6800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X Primary

Addresses

Primary practice location

1089 Jason PL
Chatham, IL 62629

Mailing address

160 Progress Rd Ste 111
Hannibal, MO 63401-6630
Phone (217) 222-6800

Other practice location 1

100 W Main St
MT Sterling, IL 62353-1224
Phone (217) 483-5858

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080915000011 IL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 8426124561 Receives reassigned benefits from 11 practitioners
1 other NPI on this enrollment
Practice locations: Chatham, IL; Mt Sterling, IL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Advance Physical Therapy S2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1089 Jason Pl
Chatham, IL 62629
Phone (217) 483-5858

100 W Main St
Mt Sterling, IL 62353
Phone (217) 483-5858

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1215561600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1706054400000",
    "number": "1376706234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 PROGRESS RD STE 111",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634016630",
            "telephone_number": "217-222-6800",
            "fax_number": "217-222-0037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1089 JASON PL",
            "city": "CHATHAM",
            "state": "IL",
            "postal_code": "62629",
            "telephone_number": "217-222-6800",
            "fax_number": "217-222-0037"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 W Main St",
            "address_purpose": "LOCATION",
            "city": "MT Sterling",
            "state": "IL",
            "postal_code": "623531224",
            "country_code": "US",
            "telephone_number": "217-483-5858",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ADVANCE PHYSICAL THERAPY & SPORTS MEDICINE OF CHATHAM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-09",
        "last_updated": "2024-01-24",
        "certification_date": "2024-01-24",
        "status": "A",
        "authorized_official_last_name": "REIS",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "217-222-6800",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chatham, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.