Individual provider Active NPI

Jaroslaw S Matejewski, PT

  • Physical Therapist
  • Bourbonnais, IL
National Provider Identifier
1639398191
Registry record updated Apr 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070006737 Issued in IL
Practice address
215 N Convent St
Suite 6
Bourbonnais, IL 60914-5600
Phone
(815) 928-8357
Fax
(815) 929-0492
NPI assigned
Apr 24, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2017

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 070006737 IL Primary

Addresses

Primary practice location

215 N Convent St
Suite 6
Bourbonnais, IL 60914-5600

Mailing address

625 Enterprise Dr
Oak Brook, IL 60523-8813
Phone (630) 575-1980

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041012001362 IL Practitioner - Physical Therapist in Private Practice 9931169117 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

38 S Main St
Apt a
Sugar Grove, IL 60554-5031
Phone (630) 466-5866

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070006737ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Athletico LTD Physical Therapist CurrentSince Jun 20, 2018 Accepting new patients
Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Pathology, PLLC CurrentSince Dec 17, 2018 Accepting new patients
Athletico LTD Physical Therapist CurrentSince Jun 20, 2018 Accepting new patients
Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Path Physical Therapist CurrentSince Dec 17, 2018 Accepting new patients

Locations

557 Main St NW
Bourbonnais, IL 60914
Phone (815) 839-2090

215 N Convent St
Ste 6
Bourbonnais, IL 60914
Phone (815) 928-8357

204 E Washington St
Clinton, IL 61727
Phone (217) 570-0225

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

625 Enterprise Dr
Oak Brook, IL 60523
Phone (630) 575-6250

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

38 S Main St
Apt A
Sugar Grove, IL 60554
Phone (630) 466-5866

1377 Motor Pkwy
Ste 307
Ronkonkoma, NY 11749

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": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493337600000",
    "number": "1639398191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 ENTERPRISE DR",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605238813",
            "telephone_number": "630-575-1980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 N CONVENT ST",
            "address_2": "SUITE 6",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609145600",
            "telephone_number": "815-928-8357",
            "fax_number": "815-929-0492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MATEJEWSKI",
        "first_name": "JAROSLAW",
        "middle_name": "S",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-24",
        "last_updated": "2017-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070006737",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Apr 28, 2017; 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.