Individual provider Active NPI

Douglas Ryan Krebs, DC

  • Chiropractor
  • Chicago, IL
National Provider Identifier
1558487728
Registry record updated Jul 14, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038-009427 Issued in IL
Practice address
922 W Diversey Pkwy
Chicago, IL 60614-1416
Phone
(773) 529-0057
Fax
(773) 529-0231
NPI assigned
Mar 21, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038-009427 IL Primary

Addresses

Primary practice location

922 W Diversey Pkwy
Chicago, IL 60614-1416

Mailing address

922 W Diversey Pkwy
Chicago, IL 60614-1416
Phone (773) 529-0057

Other identifiers 2

IdentifierTypeStateIssuer
1627810OtherILBLUE CROSS BLUE SHIELD
7805296OtherILAETNA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101203000686 IL Practitioner - Chiropractic 4385831361 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
National College of Chiropractic, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chicago Spine and Sports, P.C.Group PAC ID 1759578735, 2 clinicians

Practice addresses (Care Compare)

922 W Diversey Pkwy
Chicago, IL 60614-1416
Phone (773) 529-0057

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038-009427ILMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Chicago Spine and Sports, P.C. CurrentSince Dec 3, 2010 Accepting new patients
Chicago Family Chiropractic Care PastSince Dec 3, 2010 Accepting new patients

Locations

922 W Diversey Pkwy
Chicago, IL 60614
Phone (773) 529-0057

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": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279065600000",
    "number": "1558487728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "922 W DIVERSEY PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606141416",
            "telephone_number": "773-529-0057",
            "fax_number": "773-529-0231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "922 W DIVERSEY PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606141416",
            "telephone_number": "773-529-0057",
            "fax_number": "773-529-0231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KREBS",
        "first_name": "DOUGLAS",
        "middle_name": "RYAN",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-21",
        "last_updated": "2010-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038-009427",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1627810",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7805296",
            "state": "IL"
        }
    ],
    "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 Jul 14, 2010; 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.