NPIMap

Individual provider Active NPI

Anthony Pendolino, D.C., DIPL. ACUP.

  • Chiropractor
  • Plainfield, IL
National Provider Identifier
1780779975
Registry record updated Jul 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
038-007415 Issued in IL
Practice address
15715 S Route 59
Plainfield, IL 60544
Phone
(815) 436-1191
Fax
(815) 436-1296
NPI assigned
Oct 4, 2006
Last updated
Jul 22, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 038-007415 IL Primary
Acupuncturist 171100000X 198-00373 IL

Addresses

Primary practice location

15715 S Route 59
Plainfield, IL 60544

Mailing address

15715 S Route 59
Plainfield, IL 60544
Phone (815) 436-1191

Other identifiers 5

IdentifierTypeStateIssuer
099-05743OtherILBC/BS
200511800OtherILOWCP
350039985OtherILRAILROAD MEDICARE
5797137OtherILAENTA
318-6341OtherILCIGNA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051102001038 IL Practitioner - Chiropractic 8325066962 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
038-007415ILMDChiropractor
198-00373ILMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Anthony Pendolino, LLC Chiropractor CurrentSince Jul 18, 2005 Accepting new patients
Pure Health Integrated Medicine Acupuncturist Past Accepting new patients

Locations

15715 S Route 59
Plainfield, IL 60544
Phone (630) 951-0037

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1595376000000",
    "number": "1780779975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15715 S ROUTE 59",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "60544",
            "telephone_number": "815-436-1191",
            "fax_number": "815-436-1296"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15715 S ROUTE 59",
            "city": "PLAINFIELD",
            "state": "IL",
            "postal_code": "60544",
            "telephone_number": "815-436-1191",
            "fax_number": "815-436-1296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDOLINO",
        "first_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "D.C., DIPL. ACUP.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2020-07-22",
        "certification_date": "2020-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IL",
            "license": "038-007415",
            "primary": true
        },
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "IL",
            "license": "198-00373",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "099-05743",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OWCP",
            "identifier": "200511800",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "350039985",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AENTA",
            "identifier": "5797137",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "318-6341",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plainfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.