Individual provider Active NPI

Shaun Tu, PT

  • Physical Therapist
  • Chicago, IL
National Provider Identifier
1417476300
Registry record updated Nov 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070.022961 Issued in IL
Practice address
2659 W Fullerton Ave
Chicago, IL 60647-3013
Phone
(773) 252-4921
Fax
(773) 252-5067
NPI assigned
Sep 12, 2017
Last updated
Nov 26, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070.022961 IL Primary
Pediatric Physical Therapist 2251P0200X NU

Addresses

Primary practice location

2659 W Fullerton Ave
Chicago, IL 60647-3013

Mailing address

1748 N Honore St Apt 1
Chicago, IL 60622-0097
Phone (650) 387-2323

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211229000549 IL Practitioner - Physical Therapist in Private Practice 9931590064 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Real PT LLCGroup PAC ID 4789015983, 6 clinicians

Practice addresses (Care Compare)

1659 W Hubbard St
Chicago, IL 60622-6352
Phone (312) 489-8579

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070.022961ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Rci (WRS), LLC. Physical Therapist Current Accepting new patients
Rci (WRS), LLC CurrentSince Dec 6, 2021 Accepting new patients
Rci (WRS), LLC. Physical Therapist CurrentSince Dec 6, 2021 Accepting new patients
Eyas Landing, Inc. Pediatrics Past Accepting new patients

Locations

2569 W Fullerton Ave
Chicago, IL 60647
Phone (773) 252-4921

826 W Touhy Ave
Park Ridge, IL 60068
Phone (847) 720-4165

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1505174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637884800000",
    "number": "1417476300",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1748 N HONORE ST APT 1",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606220097",
            "telephone_number": "650-387-2323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2659 W FULLERTON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606473013",
            "telephone_number": "773-252-4921",
            "fax_number": "773-252-5067"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TU",
        "first_name": "SHAUN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-12",
        "last_updated": "2021-11-26",
        "certification_date": "2021-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.022961",
            "primary": true
        },
        {
            "code": "2251P0200X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "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 Nov 26, 2021; 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.