NPIMap

Organization Active NPI

Panoptic Physical Therapy LLC

  • Physical Medicine & Rehabilitation Physician
  • Bourbonnais, IL
National Provider Identifier
1740843267
Registry record updated May 14, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
PANOPTIC PHYSICAL THERAPY LLC
Doing business as
Panoptic Physical Therapy - Bourbonnais
Practice address
1511 N. Convent St Suite 1000
Bourbonnais, IL 60914
Phone
(815) 401-5102
Fax
(815) 401-5103
NPI assigned
Apr 19, 2019
Organization subpart
Yes
Parent organization
PANOPTIC PHYSICAL THERAPY, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 14, 2019

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

Authorized official

Name
Gerald Edward Mertes III
Title
Chief Operating Officer
Phone
(815) 513-3298

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208100000X Primary

Addresses

Primary practice location

1511 N. Convent St Suite 1000
Bourbonnais, IL 60914

Mailing address

1802 N Division St Suite 202
Morris, IL 60450
Phone (815) 513-3298

Other names 1

  • Panoptic Physical Therapy - Bourbonnais Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Panoptic Physical Therapy LLC2 organizations share this tax ID, including this one
Part of
Panoptic Physical Therapy LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1555632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1557792000000",
    "number": "1740843267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1802 N DIVISION ST SUITE 202",
            "city": "MORRIS",
            "state": "IL",
            "postal_code": "60450",
            "telephone_number": "815-513-3298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1511 N. CONVENT ST SUITE 1000",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "60914",
            "telephone_number": "815-401-5102",
            "fax_number": "815-401-5103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANOPTIC PHYSICAL THERAPY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PANOPTIC PHYSICAL THERAPY, LLC",
        "enumeration_date": "2019-04-19",
        "last_updated": "2019-05-14",
        "status": "A",
        "authorized_official_last_name": "MERTES",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "CHIEF  OPERATING OFFICER",
        "authorized_official_telephone_number": "815-513-3298",
        "authorized_official_name_suffix": "III"
    },
    "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": "Panoptic Physical Therapy - Bourbonnais",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Panoptic Physical Therapy - Bourbonnais",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bourbonnais, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2019; 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.