Individual provider Active NPI

Robert Hodges, DPT

  • Physical Therapist
  • Oak Lawn, IL
National Provider Identifier
1699107219
Registry record updated Nov 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070020747 Issued in IL
Practice address
5255 W 95TH St
Oak Lawn, IL 60453-2450
Phone
(708) 424-2977
Fax
(708) 424-2988
NPI assigned
Aug 6, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2014

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 10436 AZ
Physical Therapist 225100000X 070020747 IL Primary

Addresses

Primary practice location

5255 W 95TH St
Oak Lawn, IL 60453-2450

Mailing address

790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2222

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201201001667 AK Practitioner - Physical Therapist in Private Practice 9234373093 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Revolution Sport and Spine Therapy LLCGroup PAC ID 6507146412, 19 clinicians

Practice addresses (Care Compare)

35249 Kenai Spur Hwy
Suite C
Soldotna, AK 99669-7673
Phone (907) 420-0836

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

LicenseStateTypeSpecialty
10436AZMDPhysical Therapist
070020747ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Optimum Health and Wellness Physical Therapy, Inc. Physical Therapist CurrentSince Aug 31, 2020 Accepting new patients
Borealis Chiropractic Inc CurrentSince Feb 7, 2022 Accepting new patients
Revolution Sport & Spine Therapy LLC Physical Therapist CurrentSince Feb 7, 2022 Accepting new patients
Synergy Physical Therapy & Performance Health, LLC Physical Therapist PastSince Jun 1, 2008 Accepting new patients

Locations

4079 Tongass Ave
Ste 102
Ketchikan, AK 99901
Phone (907) 225-7808

35249 Kenai Spur Hwy
Ste C
Soldotna, AK 99669
Phone (907) 420-0836

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": "1375747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416528000000",
    "number": "1699107219",
    "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": "630-296-2222",
            "fax_number": "630-759-6106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5255 W 95TH ST",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604532450",
            "telephone_number": "708-424-2977",
            "fax_number": "708-424-2988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HODGES",
        "first_name": "ROBERT",
        "name_prefix": "Mr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-08-06",
        "last_updated": "2014-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "10436",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070020747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oak Lawn, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2014; 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.