Individual provider Active NPI

Richard Mebane, PTA

  • Physical Therapy Assistant
  • Chicago, IL
National Provider Identifier
1760913818
Registry record updated Mar 22, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Therapy AssistantTaxonomy code 225200000X
Practice address
6255 S Archer Ave
Chicago, IL 60638-2609
Phone
(773) 284-6735
Fax
(773) 284-6820
NPI assigned
Mar 21, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapy Assistant 225200000X IL Primary

Addresses

Primary practice location

6255 S Archer Ave
Chicago, IL 60638-2609

Mailing address

625 Enterprise Dr
Oak Brook, IL 60523-8813
Phone (630) 575-6250

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1490054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1490140800000",
    "number": "1760913818",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 ENTERPRISE DR",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605238813",
            "telephone_number": "630-575-6250",
            "fax_number": "630-575-7450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6255 S ARCHER AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606382609",
            "telephone_number": "773-284-6735",
            "fax_number": "773-284-6820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEBANE",
        "first_name": "RICHARD",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-21",
        "last_updated": "2017-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2017; 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.