Individual provider Active NPI

Russell Deghi

  • Physical Therapist
  • Chicago, IL
National Provider Identifier
1609415470
Registry record updated Dec 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Practice address
3229 N Broadway St
Chicago, IL 60657-3514
Phone
(773) 871-4538
NPI assigned
Dec 27, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2019

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 Primary

Addresses

Primary practice location

3229 N Broadway St
Chicago, IL 60657-3514

Mailing address

600 Oakmont LN Ste 600C
Westmont, IL 60559-5548
Phone (630) 575-6250

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200109002963 IL Practitioner - Physical Therapist in Private Practice 6709211204 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Free Body Physical Therapy Professional CorporationGroup PAC ID 5698050169, 7 clinicians

Practice addresses (Care Compare)

2618 W Division St
Suite B
Chicago, IL 60622-7107
Phone (718) 313-0438

Merit-based Incentive Payment System (MIPS)

Final score
86.32 of 100Reported as group
Quality
84.44
Promoting interoperability
99
Improvement activities
40
Cost
70.78

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Athletico LTD Physical Therapist CurrentSince Dec 30, 2019 Accepting new patients
Form Physical Therapy, LLC Physical Therapist CurrentSince Apr 1, 2024 Accepting new patients
Athletico LTD Physical Therapist CurrentSince Dec 30, 2019 Accepting new patients
Free Body Physical Therapy Professional Corporation Physical Therapist CurrentSince Apr 1, 2025 Accepting new patients

Locations

3229 N Broadway St
Chicago, IL 60657
Phone (773) 871-4538

280 N Randall Rd
Lake in the Hills, IL 60156
Phone (847) 854-8219

722 N McLean Blvd
South Elgin, IL 60177
Phone (847) 695-5088

10356 W Roosevelt Rd
Westchester, IL 60154
Phone (630) 400-6993

600 Oakmont Ln
Ste 600C
Westmont, IL 60559
Phone (630) 575-6250

Organizations & group practices 4

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": "1577404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577404800000",
    "number": "1609415470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 OAKMONT LN STE 600C",
            "city": "WESTMONT",
            "state": "IL",
            "postal_code": "605595548",
            "telephone_number": "630-575-6250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3229 N BROADWAY ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606573514",
            "telephone_number": "773-871-4538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEGHI",
        "first_name": "RUSSELL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-12-27",
        "last_updated": "2019-12-27",
        "certification_date": "2019-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "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 Dec 27, 2019; 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.