Active NPI
Jordan Fink, P.T.
- Physical Therapist
- Macomb, IL
National Provider Identifier
1467468033
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 070-014348
- Practice address
- 130 S Lafayette St
Macomb, IL 61455-2289 - Phone
- (309) 836-2500
- Fax
- (309) 836-2501
- NPI assigned
- Aug 1, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 03745 | IA | |
| Physical Therapist | 225100000X | 070-014348 | IL | Primary |
Addresses
Primary practice location
130 S Lafayette St
Macomb, IL 61455-2289
Mailing address
PO Box 5387
Bloomington, IL 61702-5387
Phone (309) 661-8823
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 070-014348 | Other | IL | IL LICENSE NO |
| 03745 | Other | IA | IA LICENSE NO |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070-014348 | IL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Physical Therapy Services, LTD | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Advanced Rehab and Sports Medicine
- Physical Therapist
- Bloomington, IL
- NPI 1437141504
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154390400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287014400000",
"number": "1467468033",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 5387",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617025387",
"telephone_number": "309-661-8823",
"fax_number": "309-661-8801"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 S LAFAYETTE ST",
"city": "MACOMB",
"state": "IL",
"postal_code": "614552289",
"telephone_number": "309-836-2500",
"fax_number": "309-836-2501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FINK",
"first_name": "JORDAN",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-01",
"last_updated": "2010-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IA",
"license": "03745",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070-014348",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IL LICENSE NO",
"identifier": "070-014348",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IA LICENSE NO",
"identifier": "03745",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Macomb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.