Prarie State Rehabilitation, LLC

Primary specialty

Pain Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081P2900X

Legal business name

PRARIE STATE REHABILITATION, LLC

Practice address

12220 S Cheyenne Dr
Palos Heights, IL 60463-1654

Phone

(708) 275-4087

NPI assigned

Oct 29, 2018

Organization subpart

No

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

Authorized official

Name

Jason Douglas Freeman, DO

Title

Owner

Phone

(708) 275-4087

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1540771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1540771200000",
    "number": "1770050668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12220 S CHEYENNE DR",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631654",
            "telephone_number": "708-275-4087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12220 S CHEYENNE DR",
            "city": "PALOS HEIGHTS",
            "state": "IL",
            "postal_code": "604631654",
            "telephone_number": "708-275-4087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRARIE STATE REHABILITATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-29",
        "last_updated": "2018-10-29",
        "status": "A",
        "authorized_official_last_name": "FREEMAN",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "DOUGLAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "708-275-4087",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Palos Heights, IL
• Providers in Palos Heights, IL by specialty
• Pain Medicine (Physical Medicine & Rehabilitation) Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2018; 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.