NPIMap

Organization Active NPI

O2 Fitness and Nutrition

  • Health Service Clinic/Center
  • Alsip, IL
National Provider Identifier
1720881212
Registry record updated Mar 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
Legal business name
O2 FITNESS AND NUTRITION
Practice address
12609 S Kroll Dr
Alsip, IL 60803-3221
Phone
(708) 969-6110
NPI assigned
Mar 31, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2025

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

Authorized official

Name
Paola Ambrose, BA, RDN, LDNNPI 1518828169
Title
Owner, RDN, LDN
Phone
(708) 819-2289

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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Meals Provider 174200000X
Health Service Clinic/Center 261QH0100X Primary
Pain Clinic/Center 261QP3300X
Rehabilitation Clinic/Center 261QR0400X
Health Maintenance Organization 302R00000X

Addresses

Primary practice location

12609 S Kroll Dr
Alsip, IL 60803-3221

Mailing address

4839 W 121St PL
Alsip, IL 60803-2943
Phone (708) 819-2289

Other names 1

  • My Life Fitness Former legal business name

National Provider Directory

National Provider Directory

Locations

12609 S Kroll Dr
Alsip, IL 60803
Phone (708) 819-2289

Practitioners & affiliated clinicians

Practitioners 1

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": "1743379200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743379200000",
    "number": "1720881212",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4839 W 121ST PL",
            "city": "ALSIP",
            "state": "IL",
            "postal_code": "608032943",
            "telephone_number": "708-819-2289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12609 S KROLL DR",
            "city": "ALSIP",
            "state": "IL",
            "postal_code": "608033221",
            "telephone_number": "708-969-6110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "O2 FITNESS AND NUTRITION",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-31",
        "last_updated": "2025-03-31",
        "certification_date": "2025-03-30",
        "status": "A",
        "authorized_official_last_name": "AMBROSE",
        "authorized_official_first_name": "PAOLA",
        "authorized_official_title_or_position": "OWNER, RDN, LDN",
        "authorized_official_telephone_number": "708-819-2289",
        "authorized_official_credential": "BA, RDN, LDN"
    },
    "taxonomies": [
        {
            "code": "174200000X",
            "taxonomy_group": "",
            "desc": "Meals",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "My Life Fitness",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Alsip, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.