Jessica Mitra

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070012836 Issued in IL

Practice address

440 E Roosevelt Rd
West Chicago, IL 60185-3918

Phone

(630) 293-5300

Fax

(630) 293-9800

NPI assigned

Jul 4, 2006

Last updated

Oct 4, 2016By the provider in NPPES

Sex

Female

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 WA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Agility PT PLLCGroup PAC ID 4183098015, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Agility PT PLLC

  dba Agility Physical Therapy

  • Physical Therapist
  • Walla Walla, WA
  • NPI 1124739693
  Medicare reassignment Care Compare group NPD
• Privia Medical Group Washington, PLLC

  dba Walla Walla Clinic (Professional)

  • Clinic/Center
  • Walla Walla, WA
  • NPI 1780658419
  Medicare reassignment

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475539200000",
    "number": "1386674174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 ENTERPRISE DR",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605238813",
            "telephone_number": "630-575-1940",
            "fax_number": "630-928-5040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 E ROOSEVELT RD",
            "city": "WEST CHICAGO",
            "state": "IL",
            "postal_code": "601853918",
            "telephone_number": "630-293-5300",
            "fax_number": "630-293-9800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITRA",
        "first_name": "JESSICA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-04",
        "last_updated": "2016-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070012836",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tamara Merrick
• Michael a Schwartzman, DPM, LTD
• Midwest Mobile Ultrasound
• Midwest X-Ray, Inc
• Melissa D Mitchell, PHARMD
• Joseph James Morley, D.C.
• Motivated Medicine, PLLC (Motivated Medicine)
• Maricarmen Moy, BA
• MTB 1, Inc.
• Nationwide DME Supplies LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2016; 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.