Individual provider Active NPI

Jennifer Weber, PT

  • Physical Therapist
  • Lake Villa, IL
National Provider Identifier
1649586116
Registry record updated Jul 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070009998 Issued in IL
Practice address
695 Park Ave
Lake Villa, IL 60046-6531
Phone
(630) 368-1776
Fax
(773) 967-1112
NPI assigned
Aug 23, 2010
Last updated
Jul 1, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 1, 2024

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 070009998 IL Primary

Addresses

Primary practice location

695 Park Ave
Lake Villa, IL 60046-6531

Mailing address

29373 Network PL
Chicago, IL 60673-1293
Phone (847) 890-5900

Other practice location 1

222 S Greenleaf St
Suite 101
Gurnee, IL 60031-5705
Phone (847) 599-9171

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address jweber399593@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180928000443 IL Practitioner - Physical Therapist in Private Practice 4486905510 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

695 Park Ave
Lake Villa, IL 60046-6531
Phone (224) 541-9100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070009998ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Creative Rehab, Inc. CurrentSince Sep 1, 2018 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince May 17, 2024 Accepting new patients
Advocate Health and Hospitals Corporation Current Accepting new patients
Advocate Health & Hospitals Corp. CurrentSince May 17, 2024 Accepting new patients

Locations

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

29373 Network Pl
Chicago, IL 60673

222 S Greenleaf St
Ste 101
Gurnee, IL 60031
Phone (847) 599-9171

495 N Riverside Dr
Ste 102
Gurnee, IL 60031
Phone (847) 599-9171

695 Park Ave
Lake Villa, IL 60046
Phone (224) 541-9100

Interoperability endpoints

  • Direct secure messaging: jweber399593@direct.myadvocateaurora.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1282521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719792000000",
    "number": "1649586116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29373 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731293",
            "telephone_number": "847-890-5900",
            "fax_number": "847-390-4757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "695 PARK AVE",
            "city": "LAKE VILLA",
            "state": "IL",
            "postal_code": "600466531",
            "telephone_number": "630-368-1776",
            "fax_number": "773-967-1112"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "222 S Greenleaf St",
            "address_2": "Suite 101",
            "address_purpose": "LOCATION",
            "city": "Gurnee",
            "state": "IL",
            "postal_code": "600315705",
            "country_code": "US",
            "telephone_number": "847-599-9171",
            "fax_number": "847-599-9124",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEBER",
        "first_name": "JENNIFER",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-08-23",
        "last_updated": "2024-07-01",
        "certification_date": "2024-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070009998",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jweber399593@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "695 Park Ave",
            "city": "Lake Villa",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600466531",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "695 Park Ave",
            "city": "Lake Villa",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600466531",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lake Villa, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2024; 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.