NPIMap

Organization Active NPI

Integrated Physical Medicine, LLC

  • Chiropractor
  • New Lenox, IL
National Provider Identifier
1700103264
Registry record updated Mar 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038.010761 Issued in IL
Legal business name
INTEGRATED PHYSICAL MEDICINE, LLC
Practice address
2499 E Joliet Hwy
New Lenox, IL 60451-2592
Phone
(815) 717-8355
Fax
(815) 717-8416
NPI assigned
Apr 23, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2022

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

Authorized official

Name
Dr. Scott Joseph Kenny, DCNPI 1679578348
Title
Owner
Phone
(815) 717-8355

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 038.010761 IL Primary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Massage TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225700000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

2499 E Joliet Hwy
New Lenox, IL 60451-2592

Mailing address

2499 E Joliet Hwy
New Lenox, IL 60451-2592
Phone (815) 717-8355

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110208000676 IL Part B Supplier - Clinic/Group Practice 4385824366 Receives reassigned benefits from 5 practitioners
Practice locations: New Lenox, IL

National Provider Directory

National Provider Directory

Locations

2499 E Joliet Hwy
New Lenox, IL 60451
Phone (815) 462-9420

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1271980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646092800000",
    "number": "1700103264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2499 E JOLIET HWY",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604512592",
            "telephone_number": "815-717-8355",
            "fax_number": "815-717-8416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2499 E JOLIET HWY",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604512592",
            "telephone_number": "815-717-8355",
            "fax_number": "815-717-8416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATED PHYSICAL MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-23",
        "last_updated": "2022-03-01",
        "certification_date": "2022-03-01",
        "status": "A",
        "authorized_official_last_name": "KENNY",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "815-717-8355",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038.010761",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Massage Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Lenox, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.