Individual provider Active NPI

Timothy E Donnelly, PT

  • Physical Therapist
  • Bourbonnais, IL
National Provider Identifier
1396838306
Registry record updated Sep 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070014399 Issued in IL
Practice address
1275 N Convent St
Suite 3
Bourbonnais, IL 60914-8210
Phone
(815) 936-1855
Fax
(815) 936-6097
NPI assigned
Oct 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2015

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 070014399 IL Primary

Addresses

Primary practice location

1275 N Convent St
Suite 3
Bourbonnais, IL 60914-8210

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20061228000312 IL Practitioner - Physical Therapist in Private Practice 8224038195 Reassigns benefits to 3 organizations
I20230725004043 IN Practitioner - Physical Therapist in Private Practice 8224038195 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10110 Donald S Powers Dr
Suite 101B
Munster, IN 46321-4070
Phone (219) 961-9480

110 Mooney Dr
Suite 5
Bourbonnais, IL 60914-2172
Phone (815) 295-8306

13963 S Bell Rd
Homer Glen, IL 60491-8503
Phone (708) 428-1700

2101 Waukegan Rd
Bannockburn, IL 60015-1836

6712 N Convent St
Bourbonnais, IL 60914-1528
Phone (815) 928-8050

Merit-based Incentive Payment System (MIPS)

Final score
81.07 of 100Reported as group
Quality
76.54
Promoting interoperability
83
Improvement activities
40
Cost
74.52

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070014399ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Illinois Bone and Joint Institute, LLC CurrentSince Mar 1, 2020 Accepting new patients
Athletic and Therapeutic Institute of Bourbonnais, LLC Physical Therapist Current Accepting new patients
Athletic & Therapeutic Institute of Bourbonnais, LLC Physical Therapist CurrentSince Sep 11, 2006 Accepting new patients
Athletic and Therapeutic Institute of Naperville LLC Physical Therapist Current Accepting new patients
Athletic and Therapeutic Institute of Naperville, LLC CurrentSince Apr 30, 2015 Accepting new patients
Athletic and Therapeutic Institute of Naperville, LLC Physical Therapist CurrentSince Apr 30, 2015 Accepting new patients
Athletic and Therapeutic Institute of Bourbonnais, LLC Physical Therapist CurrentSince Sep 11, 2006 Accepting new patients
Illinois Bone and Joint Institute LLC CurrentSince Mar 1, 2020 Accepting new patients

Locations

2101 Waukegan Rd
Ste 110
Bannockburn, IL 60015
Phone (847) 914-9096

383 W Army Trail Rd
Ste 100
Bloomingdale, IL 60108
Phone (630) 924-0367

790 Remington Blvd
Bolingbrook, IL 60440

1275 N Convent St
Ste 3
Bourbonnais, IL 60914
Phone (815) 936-1855

400 S Kennedy Dr
Ste 100
Bradley, IL 60915
Phone (815) 928-8050

4947 Paysphere Cir
Chicago, IL 60674
Phone (630) 783-2001

5057 Paysphere Cir
Chicago, IL 60674

900 Rand Rd
Ste 300
Des Plaines, IL 60016
Phone (847) 324-3090

800 Des Plaines Ave
Forest Park, IL 60130
Phone (708) 366-2442

43 Bankview Dr
Frankfort, IL 60423
Phone (815) 469-6676

19552 S Harlem Ave
Frankfort, IL 60423
Phone (815) 464-3525

1870 Silver Cross Blvd
Ste 200
New Lenox, IL 60451
Phone (630) 323-6116

967 N Green Bay Rd
Waukegan, IL 60085
Phone (224) 321-5237

109 W Geneva Rd
Wheaton, IL 60187
Phone (630) 784-3251

0S050 Winfield Rd
Ste 120
Winfield, IL 60190
Phone (630) 653-4743

10110 Donald S Powers Dr
Ste 101B
Munster, IN 46321
Phone (219) 961-8480

Organizations & group practices 8

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": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442361600000",
    "number": "1396838306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1275 N CONVENT ST",
            "address_2": "SUITE 3",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609148210",
            "telephone_number": "815-936-1855",
            "fax_number": "815-936-6097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONNELLY",
        "first_name": "TIMOTHY",
        "middle_name": "E",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2015-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070014399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bourbonnais, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2015; 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.