Azer III, P.C.

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

AZER III, P.C.

Doing business as

Azer Clinic

Practice address

872 W Dayton St
Galesburg, IL 61401-1503

Phone

(309) 344-3400

Fax

(309) 344-5040

NPI assigned

Sep 28, 2006

Last updated

Mar 16, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Fakhry Wilson Azer, P.T.NPI 1790703452

Title

President

Phone

(309) 344-3400

Specialties & licenses 4

Addresses

Other names 1

• Azer Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407948748. Details of each certification follow.

• CCN 146682 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 146682

Legal name

AZER III, PC

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Jul 17, 2002

Last certification

Dec 27, 2019

Ownership / control type

Proprietary

Facility address

872 W Dayton St
Galesburg, IL 61401

Locations

Practitioners 2

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.

• Fakhry Wilson Azer, P.T.

  • Physical Therapist
  • Galesburg, IL
  • NPI 1790703452
  NPD Authorized official
• Melissa Engebretson, P.T.

  • Physical Therapist
  • Galesburg, IL
  • NPI 1033137716
  NPD (past)

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678924800000",
    "number": "1407948748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "872 W DAYTON ST",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614011503",
            "telephone_number": "309-344-3400",
            "fax_number": "309-344-5040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "872 W DAYTON ST",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614011503",
            "telephone_number": "309-344-3400",
            "fax_number": "309-344-5040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AZER III, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2023-03-16",
        "certification_date": "2023-03-16",
        "status": "A",
        "authorized_official_last_name": "AZER",
        "authorized_official_first_name": "FAKHRY",
        "authorized_official_middle_name": "WILSON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-344-3400",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2251G0304X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Geriatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Azer Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Azer Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Linda M Auer, DO
• Ava Rose Eyecare LTD (Precision Family Eyecare)
• Susie Marie Avery, APRN
• Chris M Ayers, CNS
• Robert Ayers
• Azer Medical Supply, Inc.
• Azer Rehab Systems, P.C.
• Fakhry Wilson Azer, P.T.
• Tiffany Marie Babcock, CADC,QHEIC
• Lynn Bachelder

• Physical Therapist in Galesburg, IL
• Providers in Galesburg, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.