Bodhi & Sage, LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

070013559 Issued in IL

Legal business name

BODHI & SAGE, LLC

Practice address

1525 E 53Rd St Ste 808
Chicago, IL 60615-4583

Phone

(312) 403-1853

NPI assigned

Dec 4, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Roger Fong, MPT, LACNPI 1821352915

Title

Member

Phone

(312) 403-1853

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Tax ID family

Bodhi Sage LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Bodhi & Sage, LLC

  • Acupuncturist
  • Chicago, IL
  • NPI 1902391360
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Roger Fong, MPT

  • Physical Therapist
  • Chicago, IL
  • NPI 1821352915

  Acupuncturist

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1449187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449532800000",
    "number": "1538534359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 E 53RD ST STE 808",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606154583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 E 53RD ST STE 808",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606154583",
            "telephone_number": "312-403-1853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BODHI & SAGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-04",
        "last_updated": "2015-12-08",
        "status": "A",
        "authorized_official_last_name": "FONG",
        "authorized_official_first_name": "ROGER",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "312-403-1853",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPT, LAC"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Acupuncturist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "IL",
            "license": "070013559",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trista Ann Boden
• Philip Charles Bodenstab Jr., MD
• Anne Bodenstine, PT
• Alaya Bodepudi, MD
• Matthew Ryan Bodett
• Bodhi & Sage, LLC
• Bodhi Tree Center for Holistic Therapy LLC
• Bodi by Me Med Spa LLC
• Christine Heidi Anne Bodine, MD
• Brittany Bodkin, LCSW

• Physical Therapy Clinic/Center in Chicago, IL
• Providers in Chicago, IL by specialty
• Physical Therapy Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2015; 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.