Active NPI
Eric Ken Schrock, MSTOM, L.AC, DIPL OM
- Acupuncturist
- Chicago, IL
National Provider Identifier
1457829608
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acupuncturist
- License
- 198.001352
- Practice address
- 1741 W Division St
Chicago, IL 60622-3216 - Phone
- (773) 504-3979
- NPI assigned
- Nov 6, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acupuncturist | 171100000X | 198.001352 | IL | Primary |
Addresses
Primary practice location
1741 W Division St
Chicago, IL 60622-3216
Mailing address
5241 N Melvina Ave
Chicago, IL 60630-1036
Phone (773) 504-3979
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 198.001352 | Other | IL | ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 198.001352 | IL | MD | Acupuncturist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Active Wellness, LLC | Acupuncturist | Past | Accepting new patients |
| Active Wellness, LLC | Acupuncturist | Past | Accepting new patients |
| Active Wellness LLC | Acupuncturist | Past | Accepting new patients |
Organizations & group practices 3
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": "1541462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1541462400000",
"number": "1457829608",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5241 N MELVINA AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606301036",
"telephone_number": "773-504-3979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1741 W DIVISION ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606223216",
"telephone_number": "773-504-3979"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCHROCK",
"first_name": "ERIC",
"middle_name": "KEN",
"name_prefix": "Mr.",
"credential": "MSTOM, L.AC, DIPL OM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-11-06",
"last_updated": "2018-11-06",
"status": "A"
},
"taxonomies": [
{
"code": "171100000X",
"taxonomy_group": "",
"desc": "Acupuncturist",
"state": "IL",
"license": "198.001352",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION",
"identifier": "198.001352",
"state": "IL"
}
],
"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 6, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.