Prairie State Rehab, LLC

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

Legal business name

PRAIRIE STATE REHAB, LLC

Practice address

711 S Dearborn St Unit 705
Chicago, IL 60605-3820

Phone

(708) 966-9283

Fax

(708) 258-1632

NPI assigned

Dec 10, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Jason Freeman, DONPI 1104179142

Title

Ceo

Phone

(708) 275-4087

Specialties & licenses 1

Addresses

Other names 1

• Prairie State Rehab, LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 2

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

• Jason Douglas Freeman, D.O.

  • Physical Medicine & Rehabilitation Physician
  • Chicago, IL
  • NPI 1104179142
  Medicare reassignment NPD Authorized official
• Samantha Donmez, NP

  • Family Nurse Practitioner
  • Walnut, CA
  • NPI 1861076119

  IL

  Medicare reassignment NPD

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

{
    "created_epoch": "1607558400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607558400000",
    "number": "1700482114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 S DEARBORN ST UNIT 705",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606053820",
            "telephone_number": "708-966-9283",
            "fax_number": "708-258-1632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 S DEARBORN ST UNIT 705",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606053820",
            "telephone_number": "708-966-9283",
            "fax_number": "708-258-1632"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE STATE REHAB, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-10",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-10",
        "status": "A",
        "authorized_official_last_name": "FREEMAN",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "708-275-4087",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prairie State Rehab, LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary Kathryn Prahl, M.D.
• Praire Shores Dental
• Prairie Anesthesia LLC
• Prairie Foot & Ankle, P.C.
• Prairie Medical Associates
• Prairieland Therapy LLC
• Snahel M Prajapati, D.M.D.
• Timothy David Prajka, DO
• Soumiya Prakasam, MD
• Prakash K Upadhyaya DDS LTD

• Physical Medicine & Rehabilitation Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Physical Medicine & Rehabilitation Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2020; 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.