Individual provider Active NPI

Kristin Pergander, PT, DPT

  • Physical Therapist
  • Lake Villa, IL
National Provider Identifier
1487065025
Registry record updated Mar 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070.020225 Issued in IL
Practice address
695 Park Ave
Lake Villa, IL 60046-6531
Phone
(630) 368-1776
Fax
(773) 967-1112
NPI assigned
May 16, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2024

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 070.020225 IL Primary

Addresses

Primary practice location

695 Park Ave
Lake Villa, IL 60046-6531

Mailing address

29373 Network PL
Chicago, IL 60673-1293
Phone (847) 390-5900

Other practice location 1

1405 N Hunt Club Rd
Gurnee, IL 60031-2656
Phone (847) 855-2890

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address kpergander233074@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140609000750 IL Practitioner - Physical Therapist in Private Practice 9133343304 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

214 McHenry Rd
Buffalo Grove, IL 60089-6748
Phone (847) 459-1160

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070.020225ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health & Hospitals Corp. CurrentSince Apr 28, 2024 Accepting new patients
Advocate Health and Hospitals Corporation Current Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Apr 28, 2024 Accepting new patients
Lake Zurich Physical Medicine, SC Past Accepting new patients
Advocate Condell Medical Center PastSince Jan 1, 2021 Accepting new patients

Locations

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

29373 Network Pl
Chicago, IL 60673

695 Park Ave
Lake Villa, IL 60046
Phone (224) 541-9100

Organizations & group practices 5

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": "1400198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711670400000",
    "number": "1487065025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29373 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731293",
            "telephone_number": "847-390-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "695 PARK AVE",
            "city": "LAKE VILLA",
            "state": "IL",
            "postal_code": "600466531",
            "telephone_number": "630-368-1776",
            "fax_number": "773-967-1112"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1405 N Hunt Club Rd",
            "address_purpose": "LOCATION",
            "city": "Gurnee",
            "state": "IL",
            "postal_code": "600312656",
            "country_code": "US",
            "telephone_number": "847-855-2890",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PERGANDER",
        "first_name": "KRISTIN",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-16",
        "last_updated": "2024-03-29",
        "certification_date": "2024-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.020225",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kpergander233074@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "695 Park Ave",
            "city": "Lake Villa",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600466531",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "695 Park Ave",
            "city": "Lake Villa",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600466531",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lake Villa, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2024; 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.