Individual provider Active NPI

Patricia Staszak

  • Physical Therapist
  • Chicago, IL
National Provider Identifier
1477601227
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
5414 N Broadway St
Chicago, IL 60640-1704
Phone
(773) 907-3599
Fax
(773) 907-3510
NPI assigned
Jan 8, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X IL Primary

Addresses

Primary practice location

5414 N Broadway St
Chicago, IL 60640-1704

Mailing address

5414 N Broadway St
Chicago, IL 60640-1704
Phone (773) 907-3599

Other identifiers 1

IdentifierTypeStateIssuer
1623236OtherILBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050201000413 IL Practitioner - Physical Therapist in Private Practice 2769433366 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Andersonville Physical Therapy, SCGroup PAC ID 9133170731, 10 clinicians

Practice addresses (Care Compare)

5414 N Broadway St
Chicago, IL 60640-1704
Phone (773) 907-3599

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070008600ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Andersonville Physical Therapy, SC Physical Therapist CurrentSince Oct 27, 1999 Accepting new patients

Locations

5414 N Broadway St
Chicago, IL 60640
Phone (773) 907-3599

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.

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1477601227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5414 N BROADWAY ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606401704",
            "telephone_number": "773-907-3599",
            "fax_number": "773-907-3510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5414 N BROADWAY ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606401704",
            "telephone_number": "773-907-3599",
            "fax_number": "773-907-3510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STASZAK",
        "first_name": "PATRICIA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1623236",
            "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 Jul 8, 2007; 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.