Active NPI
John Keith Vavrinak
- Physical Therapist
- Naperville, IL
National Provider Identifier
1770062820
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 4500
- Practice address
- 2547 Plainfield Naperville Rd Ste 152
Naperville, IL 60564-8701 - Phone
- (800) 974-4378
- Fax
- (630) 515-1536
- NPI assigned
- Aug 9, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 4500 | OK | Primary |
Addresses
Primary practice location
2547 Plainfield Naperville Rd Ste 152
Naperville, IL 60564-8701
Mailing address
2547 Plainfield Naperville Rd Ste 152
Naperville, IL 60564-8701
Phone (800) 974-4378
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4500 | Other | OK | STATE LICENSE |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4500 | OK | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1533772800000",
"number": "1770062820",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2547 PLAINFIELD NAPERVILLE RD STE 152",
"city": "NAPERVILLE",
"state": "IL",
"postal_code": "605648701",
"telephone_number": "800-974-4378",
"fax_number": "630-515-1536"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2547 PLAINFIELD NAPERVILLE RD STE 152",
"city": "NAPERVILLE",
"state": "IL",
"postal_code": "605648701",
"telephone_number": "800-974-4378",
"fax_number": "630-515-1536"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAVRINAK",
"first_name": "JOHN",
"middle_name": "KEITH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-08-09",
"last_updated": "2018-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "OK",
"license": "4500",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "4500",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Naperville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 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.