Individual provider Active NPI

Drew Mullenix

  • Physical Therapist
  • Champaign, IL
National Provider Identifier
1487499687
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
602 S Neil St
Champaign, IL 61820-5475
Phone
(217) 649-0504
NPI assigned
Jun 28, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 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 Primary

Addresses

Primary practice location

602 S Neil St
Champaign, IL 61820-5475

Mailing address

602 S Neil St
Champaign, IL 61820-5475

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240827002946 IL Practitioner - Physical Therapist in Private Practice 0244779825 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Impact Physical Therapy, LLCGroup PAC ID 2466998398, 43 clinicians

Practice addresses (Care Compare)

602 S Neil St
Champaign, IL 61820-5765
Phone (217) 649-0504

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ipt Management Services, Inc. Physical Therapist CurrentSince Jun 24, 2024 Accepting new patients
Impact Physical Therapy, LLC Physical Therapist CurrentSince Aug 1, 2024 Accepting new patients

Locations

602 S Neil St
Champaign, IL 61820
Phone (217) 649-0504

602 S Neil St
Ste A
Champaign, IL 61820
Phone (217) 649-0504

1103 S State St
Ste 300
Chicago, IL 60605
Phone (312) 877-5101

Organizations & group practices 2

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": "1719532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719532800000",
    "number": "1487499687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 S NEIL ST",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618205475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 S NEIL ST",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618205475",
            "telephone_number": "217-649-0504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLENIX",
        "first_name": "DREW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-28",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Champaign, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 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.