Individual provider Active NPI

Mohamad Ahmed Hassan, PT

  • Physical Therapist
  • Orland Park, IL
National Provider Identifier
1487212536
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070024359 Issued in IL
Practice address
14474 S la Grange Rd
Orland Park, IL 60462-2506
Phone
(084) 608-0807
Fax
(630) 920-4687
NPI assigned
Jun 4, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 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 070024359 IL Primary

Addresses

Primary practice location

14474 S la Grange Rd
Orland Park, IL 60462-2506

Mailing address

570 Village Center Dr Ste 205
Burr Ridge, IL 60527-4526
Phone (630) 920-4670

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190802002661 IL Practitioner - Physical Therapist in Private Practice 5698001733 Reassigns benefits to 1 organization
I20251209000651 IN Practitioner - Physical Therapist in Private Practice 5698001733 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Des Moines University of Osteopathic Medicine and Health Sciences, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Physical Therapy PCGroup PAC ID 0446214845, 12 clinicians

Practice addresses (Care Compare)

3900 W 95TH St
Evergreen Park, IL 60805-1922
Phone 63092046706

8159 Calumet Ave
Munster, IN 46321-1701
Phone (630) 920-4670

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070024359ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Physical Therapy PC Physical Therapist CurrentSince Jun 26, 2019 Accepting new patients

Locations

570 Village Center Dr
Ste 205
Burr Ridge, IL 60527

4455 W Grand Ave
Chicago, IL 60639
Phone (630) 575-6250

14474 S La Grange Rd
Orland Park, IL 60462
Phone (708) 460-8080

8159 Calumet Ave
Munster, IN 46321
Phone (219) 836-2800

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": "1559606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1487212536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "570 VILLAGE CENTER DR STE 205",
            "city": "BURR RIDGE",
            "state": "IL",
            "postal_code": "605274526",
            "telephone_number": "630-920-4670",
            "fax_number": "630-920-4687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14474 S LA GRANGE RD",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604622506",
            "telephone_number": "084-608-0807",
            "fax_number": "630-920-4687"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HASSAN",
        "first_name": "MOHAMAD",
        "middle_name": "AHMED",
        "name_prefix": "Dr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-04",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070024359",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orland Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 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.