Individual provider Active NPI

Ryan A Carroll, DPT

  • Physical Therapist
  • Grayslake, IL
National Provider Identifier
1497274732
Registry record updated Sep 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070.023161 Issued in IL
Practice address
997 N Corporate Cir Ste B
Grayslake, IL 60030-7822
Phone
(847) 223-8001
Fax
(847) 986-3580
NPI assigned
Sep 19, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2017

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 070.023161 IL Primary

Addresses

Primary practice location

997 N Corporate Cir Ste B
Grayslake, IL 60030-7822

Mailing address

997 N Corporate Cir Ste B
Grayslake, IL 60030-7822

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171127001189 IL Practitioner - Physical Therapist in Private Practice 1850658089 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grayslake Rehabilitation and Complete Physical Therapy LLCGroup PAC ID 4183679400, 13 clinicians

Practice addresses (Care Compare)

997 N Corporate Cir
Suite B
Grayslake, IL 60030-7822
Phone (847) 223-8001

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070.023161ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Caitlin Chandran MSN, Aprn-Fpa, FNP-BC PLLC CurrentSince Oct 11, 2022 Accepting new patients
Grayslake Rehabilitation and Complete Physical Therapy LLC Physical Therapist CurrentSince Oct 19, 2017 Accepting new patients

Locations

997 N Corporate Cir
Ste B
Grayslake, IL 60030
Phone (847) 223-8001

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": "1505779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505779200000",
    "number": "1497274732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "997 N CORPORATE CIR STE B",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600307822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "997 N CORPORATE CIR STE B",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600307822",
            "telephone_number": "847-223-8001",
            "fax_number": "847-986-3580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "RYAN",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-19",
        "last_updated": "2017-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.023161",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grayslake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2017; 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.