Individual provider Active NPI

Kristopher John Heitzig, DPT

  • Physical Therapist
  • Rockford, IL
National Provider Identifier
1548497803
Registry record updated Sep 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070017180 Issued in IL
Practice address
735 Highgrove PL
Rockford, IL 61108-2520
Phone
(815) 226-4365
NPI assigned
Jun 15, 2009
Last updated
Sep 10, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2012

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 070017180 IL Primary

Addresses

Primary practice location

735 Highgrove PL
Rockford, IL 61108-2520

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2233

Other identifiers 1

IdentifierTypeStateIssuer
P01061416OtherILMEDICARE RAILROAD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090826000828 IL Practitioner - Physical Therapist in Private Practice 2668527656 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1002 Commons Dr
Geneva, IL 60134-2539
Phone (630) 208-7831

1275 N Convent St
Suite 3
Bourbonnais, IL 60914-8211
Phone (815) 936-1855

2121 Sycamore Rd
Dekalb, IL 60115-2045
Phone (630) 355-5255

410 E Church St
Sandwich, IL 60548-2380
Phone (815) 786-3123

Merit-based Incentive Payment System (MIPS)

Final score
85.61 of 100Reported as group
Quality
90
Improvement activities
40
Cost
70.36

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070017180ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Athletic and Therapeutic Institute of Bourbonnais, LLC Physical Therapist Current Accepting new patients
Athletic and Therapeutic Institute of Naperville LLC Physical Therapist CurrentSince Jun 12, 2022 Accepting new patients
Athletic & Therapeutic Institute of Bourbonnais, LLC Physical Therapist CurrentSince Jun 1, 2017 Accepting new patients
Athletic and Therapeutic Institute of Naperville, LLC CurrentSince Jun 12, 2022 Accepting new patients
Athletic and Therapeutic Institute of Bourbonnais, LLC Physical Therapist CurrentSince Jun 1, 2017 Accepting new patients
Athletic and Therapeutic Institute of Naperville, LLC Physical Therapist PastSince Aug 28, 2007 Accepting new patients

Locations

790 Remington Blvd
Bolingbrook, IL 60440

1275 N Convent St
Ste 3
Bourbonnais, IL 60914
Phone (815) 936-1855

4947 Paysphere Cir
Chicago, IL 60674
Phone (630) 783-2001

800 Des Plaines Ave
Forest Park, IL 60130
Phone (708) 366-2442

2940 Rollingridge Rd
Ste 100
Naperville, IL 60564
Phone (630) 369-4771

4511 State Route 71
Oswego, IL 60543
Phone (630) 544-7815

735 Highgrove Pl
Rockford, IL 61108
Phone (815) 226-4365

2325 W Monroe St
Springfield, IL 62704
Phone (217) 241-0270

967 N Green Bay Rd
Waukegan, IL 60085
Phone (224) 321-5237

109 W Geneva Rd
Wheaton, IL 60187
Phone (630) 784-3251

0S050 Winfield Rd
Ste 120
Winfield, IL 60190
Phone (630) 653-4743

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1245024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347235200000",
    "number": "1548497803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 REMINGTON BLVD",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404909",
            "telephone_number": "630-296-2233"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "735 HIGHGROVE PL",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611082520",
            "telephone_number": "815-226-4365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEITZIG",
        "first_name": "KRISTOPHER",
        "middle_name": "JOHN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-15",
        "last_updated": "2012-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070017180",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P01061416",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2012; 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.