NPIMap

Organization Active NPI

Physical Medicine Associates SC

  • Family Medicine Physician
  • Geneva, IL
National Provider Identifier
1477546935
Registry record updated May 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
042617710 Issued in IL
Legal business name
PHYSICAL MEDICINE ASSOCIATES SC
Practice address
429 N Kirk Rd Ste 103
Geneva, IL 60134-1667
Phone
(630) 605-6323
Fax
(630) 428-4305
NPI assigned
Aug 30, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2022

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

Authorized official

Name
Taryn Hall
Title
Om
Phone
(630) 450-2088

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 042617710 IL
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 042617710 IL Primary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X 042617710 IL

Addresses

Primary practice location

429 N Kirk Rd Ste 103
Geneva, IL 60134-1667

Mailing address

24W500 Maple Ave
#105
Naperville, IL 60540-6055
Phone (630) 428-4300

Other practice location 1

2745 Maple Ave Ste 2D
Lisle, IL 60532-3231
Phone (630) 428-4300

Other identifiers 1

IdentifierTypeStateIssuer
02232261OtherILBCBS PROVIDER #

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040203000658 IL Part B Supplier - Clinic/Group Practice 3971496134 Receives reassigned benefits from 6 practitioners
Practice locations: Geneva, IL

National Provider Directory

National Provider Directory

Locations

429 N Kirk Rd
Ste 103
Geneva, IL 60134
Phone (630) 605-6323

2745 Maple Ave
Ste 2D
Lisle, IL 60532
Phone (630) 428-4300

600 E Diehl Rd
Ste 150
Naperville, IL 60563

24W500 Maple Ave
Ste 105
Naperville, IL 60540
Phone (630) 428-4300

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652918400000",
    "number": "1477546935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24W500 MAPLE AVE",
            "address_2": "#105",
            "city": "NAPERVILLE",
            "state": "IL",
            "postal_code": "605406055",
            "telephone_number": "630-428-4300",
            "fax_number": "630-428-4305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "429 N KIRK RD STE 103",
            "city": "GENEVA",
            "state": "IL",
            "postal_code": "601341667",
            "telephone_number": "630-605-6323",
            "fax_number": "630-428-4305"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2745 Maple Ave Ste 2D",
            "address_purpose": "LOCATION",
            "city": "Lisle",
            "state": "IL",
            "postal_code": "605323231",
            "country_code": "US",
            "telephone_number": "630-428-4300",
            "fax_number": "630-428-4305",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PHYSICAL MEDICINE ASSOCIATES SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-30",
        "last_updated": "2022-05-19",
        "certification_date": "2022-05-19",
        "status": "A",
        "authorized_official_last_name": "HALL",
        "authorized_official_first_name": "TARYN",
        "authorized_official_title_or_position": "OM",
        "authorized_official_telephone_number": "630-450-2088"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "042617710",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "042617710",
            "primary": true
        },
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "IL",
            "license": "042617710",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "02232261",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Geneva, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.