NPIMap

Organization Active NPI

Bravehearts at the Bergmann Center

  • Physical Therapist
  • Poplar Grove, IL
National Provider Identifier
1497060743
Registry record updated Aug 11, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070008709 Issued in IL
Legal business name
BRAVEHEARTS AT THE BERGMANN CENTER
Practice address
4950 Il Route 173
Poplar Grove, IL 61065-9718
Phone
(815) 765-2113
Fax
(815) 943-8426
NPI assigned
Aug 11, 2010
Last updated
Aug 11, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2010

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

Authorized official

Name
Dr. Rolf M. Gunnar, M.D.
Title
Chairman of the Board of Directors
Phone
(708) 485-5629

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X 070008709 IL Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X 056004082 IL
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X 146004807 IL

Addresses

Primary practice location

4950 Il Route 173
Poplar Grove, IL 61065-9718

Mailing address

4950 Il Route 173
Poplar Grove, IL 61065-9718
Phone (815) 765-2113

Other names 1

  • BraveHearts Therapeutic Riding and Education Center Former legal business name

National Provider Directory

National Provider Directory

Locations

4950 Il Route 173
Poplar Grove, IL 61065
Phone (815) 765-2113

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1281484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281484800000",
    "number": "1497060743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4950 IL ROUTE 173",
            "city": "POPLAR GROVE",
            "state": "IL",
            "postal_code": "610659718",
            "telephone_number": "815-765-2113",
            "fax_number": "815-943-8426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4950 IL ROUTE 173",
            "city": "POPLAR GROVE",
            "state": "IL",
            "postal_code": "610659718",
            "telephone_number": "815-765-2113",
            "fax_number": "815-943-8426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAVEHEARTS AT THE BERGMANN CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-11",
        "last_updated": "2010-08-11",
        "status": "A",
        "authorized_official_last_name": "GUNNAR",
        "authorized_official_first_name": "ROLF",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CHAIRMAN OF THE BOARD OF DIRECTORS",
        "authorized_official_telephone_number": "708-485-5629",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070008709",
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": "056004082",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146004807",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BraveHearts Therapeutic Riding and Education Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Poplar Grove, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.