Individual provider Active NPI

Emerald Jaudian Perez, PT

  • Physical Therapist
  • Chicago, IL
National Provider Identifier
1386084739
Registry record updated Jun 30, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070017585 Issued in IL
Practice address
8443 W Brodman Ave
Chicago, IL 60656-4218
Phone
(630) 767-9123
NPI assigned
Jun 30, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 30, 2013

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 070017585 IL Primary

Addresses

Primary practice location

8443 W Brodman Ave
Chicago, IL 60656-4218

Mailing address

8443 W Brodman Ave
Chicago, IL 60656-4218
Phone (630) 767-9123

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131104001195 IL Practitioner - Physical Therapist in Private Practice 6800020868 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070017585ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Thorek Memorial Hospital CurrentSince Jul 5, 2023 Accepting new patients
Thorek Memorial Hospital CurrentSince Jul 5, 2023 Accepting new patients

Organizations & group practices 2

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": "1372550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372550400000",
    "number": "1386084739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8443 W BRODMAN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606564218",
            "telephone_number": "630-767-9123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8443 W BRODMAN AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606564218",
            "telephone_number": "630-767-9123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "EMERALD",
        "middle_name": "JAUDIAN",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-06-30",
        "last_updated": "2013-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070017585",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2013; 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.