Individual provider Active NPI

Ryan Michael Pelo, DPT

  • Physical Therapist
  • Chicago, IL
National Provider Identifier
1497045777
Registry record updated Nov 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
93143942401 Issued in UT
Practice address
345 E Superior St
Chicago, IL 60611-2654
Phone
(312) 238-1000
NPI assigned
Apr 7, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 11, 2021

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 93143942401 UT Primary

Addresses

Primary practice location

345 E Superior St
Chicago, IL 60611-2654

Mailing address

127S 500 E
Suite 600
Salt Lake City, UT 84102-1971
Phone (801) 587-6336

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rpelo148650@direct.med.utah.edu Direct UNIVERSITY OF UTAH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150825003840 UT Practitioner - Physical Therapist in Private Practice 2860708609 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
93143942401UTMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Metrodora ASC, LLC CurrentSince Jul 7, 2023 Accepting new patients
University of Utah Adult Services Current Accepting new patients
University of Utah Adult Services CurrentSince Dec 1, 2022 Accepting new patients
University of Utah Adult Services CurrentSince Dec 1, 2022 Accepting new patients

Locations

127 S 500 E
Ste 400B
Salt Lake City, UT 84102
Phone (801) 587-6478

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

3535 S Market St
West Valley City, UT 84119
Phone (385) 430-1430

Interoperability endpoints

  • Direct secure messaging: rpelo148650@direct.med.utah.edu
  • Direct secure messaging: ryan.pelo.1@16948.direct.athenahealth.com

Organizations & group practices 4

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": "1302134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636588800000",
    "number": "1497045777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127S 500 E",
            "address_2": "SUITE 600",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841021971",
            "telephone_number": "801-587-6336",
            "fax_number": "801-715-8228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "345 E SUPERIOR ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112654",
            "telephone_number": "312-238-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PELO",
        "first_name": "RYAN",
        "middle_name": "MICHAEL",
        "credential": "DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-04-07",
        "last_updated": "2021-11-11",
        "certification_date": "2021-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "UT",
            "license": "93143942401",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rpelo148650@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "UNIVERSITY OF UTAH",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Nov 11, 2021; 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.