Individual provider Active NPI

David T Fosburgh, DPT

  • Physical Therapist
  • Pekin, IL
National Provider Identifier
1659898955
Registry record updated Apr 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070-023454 Issued in IL
Practice address
3289 Court St
Pekin, IL 61554-6208
Phone
(309) 347-0090
Fax
(309) 347-0098
NPI assigned
Aug 28, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070-023454 IL Primary
Physical Therapist 225100000X

Addresses

Primary practice location

3289 Court St
Pekin, IL 61554-6208

Mailing address

2122 York Rd Ste 300
Oak Brook, IL 60523-1925
Phone (630) 575-1980

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190513000635 IL Practitioner - Physical Therapist in Private Practice 4183997778 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Athletico LTDGroup PAC ID 4789602681, 2,187 clinicians

Practice addresses (Care Compare)

3289 Court St
Pekin, IL 61554-6208
Phone (309) 347-0090

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

State licenses

LicenseStateTypeSpecialty
070-023454ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Athletico LTD Physical Therapist CurrentSince Apr 11, 2022 Accepting new patients
Athletico LTD Physical Therapist CurrentSince Apr 11, 2022 Accepting new patients

Locations

1047 Century Dr
Edwardsville, IL 62025
Phone (618) 307-3434

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

2122 York Rd
Ste 300
Oak Brook, IL 60523
Phone (630) 575-6250

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

3289 Court St
Pekin, IL 61554
Phone (309) 347-0090

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

951 Waterbury Falls Dr
O Fallon, MO 63368
Phone (636) 336-0300

107 Concord Plaza Shopping Ctr
Saint Louis, MO 63128
Phone (314) 842-2990

107 Progress Pkwy
Sullivan, MO 63080
Phone (573) 860-5901

Interoperability endpoints

  • Direct secure messaging: david.fosburgh.p2@direct.athleticoltd.nextgenshare.com

Organizations & group practices 2

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": "1503878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649289600000",
    "number": "1659898955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 YORK RD STE 300",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231925",
            "telephone_number": "630-575-1980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3289 COURT ST",
            "city": "PEKIN",
            "state": "IL",
            "postal_code": "615546208",
            "telephone_number": "309-347-0090",
            "fax_number": "309-347-0098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOSBURGH",
        "first_name": "DAVID",
        "middle_name": "T",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-28",
        "last_updated": "2022-04-07",
        "certification_date": "2022-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070-023454",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pekin, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 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.