Individual provider Active NPI

Jordan Dubow, DPT

  • Physical Therapist
  • Chicago, IL
National Provider Identifier
1639726383
Registry record updated Jun 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070024480 Issued in IL
Practice address
111 North Wabash Ave Suite 100
#3279
Chicago, IL 60602-1903
Phone
(847) 987-5854
NPI assigned
Aug 19, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2022

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 070024480 IL Primary

Addresses

Primary practice location

111 North Wabash Ave Suite 100
#3279
Chicago, IL 60602-1903

Mailing address

2740 N Pine Grove Ave Apt 15B
Chicago, IL 60614-6616
Phone (847) 987-5854

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190829003974 IL Practitioner - Physical Therapist in Private Practice 5395073241 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

3161 N Broadway St
Chicago, IL 60657-4508
Phone (847) 220-4268

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070024480ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Jodi H Kirsch DC,LLC Physical Therapist CurrentSince Oct 1, 2020 Accepting new patients
Lux Concierge Physical Therapy PLLC Physical Therapist CurrentSince Dec 2, 2021 Accepting new patients
Wicker Park Spine and Stability, LLC PastSince Feb 27, 2022 Accepting new patients

Locations

3161 N Broadway St
Chicago, IL 60657
Phone (847) 220-4268

212 N Carpenter St
Unit A1A2
Chicago, IL 60607

212 N Carpenter St
Chicago, IL 60607
Phone (312) 928-9282

111 N Wabash Ave
Ste 100
Chicago, IL 60602
Phone (312) 219-1597

Organizations & group practices 3

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": "1566172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655510400000",
    "number": "1639726383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2740 N PINE GROVE AVE APT 15B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606146616",
            "telephone_number": "847-987-5854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 NORTH WABASH AVE SUITE 100",
            "address_2": "#3279",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606021903",
            "telephone_number": "847-987-5854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUBOW",
        "first_name": "JORDAN",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-08-19",
        "last_updated": "2022-06-18",
        "certification_date": "2022-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070024480",
            "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 Jun 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.
  • 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.