NPIMap

Organization Active NPI

Athletic & Therapeutic Institute of Bourbonnais, LLC

  • Physical Therapist
  • Bourbonnais, IL
National Provider Identifier
1629397401
Registry record updated Feb 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
ATHLETIC & THERAPEUTIC INSTITUTE OF BOURBONNAIS, LLC
Practice address
110 Mooney Dr
Suite 5
Bourbonnais, IL 60914-2171
Phone
(815) 936-0611
Fax
(815) 936-0564
NPI assigned
May 19, 2010
Last updated
Feb 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2022

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

Authorized official

Name
Lynn McGivern
Title
Cco
Phone
(630) 296-2222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X IL Primary

Addresses

Primary practice location

110 Mooney Dr
Suite 5
Bourbonnais, IL 60914-2171

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223

Other identifiers 1

IdentifierTypeStateIssuer
1629397401MedicaidIL

Other names 1

  • ATI PT Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040923000220 IL Part B Supplier - Physical/Occupational Therapy Group in Private Practice 4183692577 Receives reassigned benefits from 405 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1296 W Boughton Rd
Bolingbrook, IL 60490
Phone (630) 771-0850

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

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

3080 Caton Farm Rd
Unit 17
Joliet, IL 60435
Phone (815) 254-3901

613 W Jefferson St
Shorewood, IL 60404
Phone (815) 553-5654

Practitioners & affiliated clinicians

Practitioners 80

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 80

NPI Registry JSON

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

{
    "created_epoch": "1274227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645142400000",
    "number": "1629397401",
    "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": "630-296-2223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 MOONEY DR",
            "address_2": "SUITE 5",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609142171",
            "telephone_number": "815-936-0611",
            "fax_number": "815-936-0564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATHLETIC & THERAPEUTIC INSTITUTE OF BOURBONNAIS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-19",
        "last_updated": "2022-02-18",
        "certification_date": "2022-02-18",
        "status": "A",
        "authorized_official_last_name": "MCGIVERN",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "CCO",
        "authorized_official_telephone_number": "630-296-2222"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629397401",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ATI PT",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "ATI PT",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Bourbonnais, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2022; 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.