Individual provider Active NPI

Nicholas J Petronovich, DPT

  • Physical Therapist
  • Chicago, IL
National Provider Identifier
1497304604
Registry record updated Jan 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070024780 Issued in IL
Practice address
259 E Erie St Ste 13-205
Chicago, IL 60611-2987
Phone
(312) 695-8143
Fax
(312) 695-4075
NPI assigned
Sep 10, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2023

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 070024780 IL Primary

Addresses

Primary practice location

259 E Erie St Ste 13-205
Chicago, IL 60611-2987

Mailing address

259 E Erie St Ste 13-205
Chicago, IL 60611-2987
Phone (312) 695-8143

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191017000388 IL Practitioner - Physical Therapist in Private Practice 3779814009 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northwestern Medical Faculty FoundationGroup PAC ID 4587576814, 4,386 clinicians

Practice addresses (Care Compare)

259 E Erie St
13TH Floor
Chicago, IL 60611-3926
Phone (312) 472-6036

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070024780ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Orthopaedics at Rush, LLC CurrentSince Oct 14, 2019 Accepting new patients
Orthomidwest, PLLC CurrentSince Jul 1, 2022 Accepting new patients
Orthomidwest, PLLC Physical Therapist CurrentSince Jul 1, 2022 Accepting new patients
Midwest Orthopaedics at Rush LLC CurrentSince Oct 14, 2019 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Dec 15, 2002 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Dec 15, 2002 Accepting new patients
Central Dupage Physician Group Past Accepting new patients

Locations

770 Beloit Rd
Belvidere, IL 61008
Phone (815) 847-7060

Dept 5777
Carol Stream, IL 60122

1611 W Harrison St
Ste 107
Chicago, IL 60612
Phone (312) 432-2513

259 E Erie St
Fl 13
Chicago, IL 60611

1611 W Harrison St
Ste 400
Chicago, IL 60612
Phone (312) 243-4244

259 E Erie St
Ste 13205
Chicago, IL 60611

1611 W Harrison St
#400
Chicago, IL 60612
Phone (312) 243-4244

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

2011 York Rd
Ste 3000
Oak Brook, IL 60523
Phone (414) 732-2577

18016 Wolf Rd
Orland Park, IL 60467
Phone (708) 364-9700

25 N Winfield Rd
Winfield, IL 60190
Phone (630) 682-1600

Organizations & group practices 7

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": "1568073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675123200000",
    "number": "1497304604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "259 E ERIE ST STE 13-205",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112987",
            "telephone_number": "312-695-8143",
            "fax_number": "312-695-4075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "259 E ERIE ST STE 13-205",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606112987",
            "telephone_number": "312-695-8143",
            "fax_number": "312-695-4075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRONOVICH",
        "first_name": "NICHOLAS",
        "middle_name": "J",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-10",
        "last_updated": "2023-01-31",
        "certification_date": "2023-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070024780",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "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 Jan 31, 2023; 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.