Individual provider Active NPI

Mike Kelvin Tolentino Esguerra

  • Occupational Therapist
  • St Charles, IL
National Provider Identifier
1457828261
Registry record updated Jun 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
056.010659 Issued in IL
Practice address
201 N Tyler Rd Apt 233
St Charles, IL 60174-2356
Phone
(312) 351-9675
NPI assigned
Oct 30, 2018
Last updated
Jun 16, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 16, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 056.010659 IL Primary

Addresses

Primary practice location

201 N Tyler Rd Apt 233
St Charles, IL 60174-2356

Mailing address

201 N Tyler Rd Apt 233
St Charles, IL 60174-2356
Phone (312) 351-9675

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200717001618 IL Practitioner - Occupational Therapist in Private Practice 6305260787 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Occupational Therapist in Private Practice
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1175 Motz St
Elburn, IL 60119-7815

300 Arlington Glen CT
Fenton, MO 63026-3973

3099 Emmons Ave
Suite 1
Brooklyn, NY 11235-1709

7 Clyde Rd
Somerset, NJ 08873-5049

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
056.010659ILMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Av360 LLC CurrentSince Dec 1, 2021 Accepting new patients
Fox Rehabilitation Services Il LLC Occupational Therapist CurrentSince Dec 1, 2022 Accepting new patients
Cortlyn Therapy, PC Occupational Therapist CurrentSince Dec 16, 2021 Accepting new patients

Locations

2140 Lake Cook Rd
Algonquin, IL 60102
Phone (224) 249-1972

28100 Torch Pkwy
Ste 600
Warrenville, IL 60555
Phone (630) 413-5817

7125 Janes Ave
Ste 300
Woodridge, IL 60517
Phone (630) 413-5817

Organizations & group practices 4

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": "1540857600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592265600000",
    "number": "1457828261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 N TYLER RD APT 233",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742356",
            "telephone_number": "312-351-9675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 N TYLER RD APT 233",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601742356",
            "telephone_number": "312-351-9675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ESGUERRA",
        "first_name": "MIKE KELVIN",
        "middle_name": "TOLENTINO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-10-30",
        "last_updated": "2020-06-16",
        "certification_date": "2020-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056.010659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Charles, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2020; 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.