Active NPI
Irene Di Minervino, DT
- Developmental Therapist
- Park Ridge, IL
National Provider Identifier
1790068443
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Developmental Therapist
- License
- IP25370711P
- Practice address
- 1208 Elm St
Park Ridge, IL 60068-3368 - Phone
- (224) 592-5862
- Fax
- (888) 491-5663
- NPI assigned
- Sep 20, 2011
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | IP25370711P | IL | Primary |
Addresses
Primary practice location
1208 Elm St
Park Ridge, IL 60068-3368
Mailing address
1208 Elm St
Park Ridge, IL 60068-3368
Phone (224) 592-5862
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 |
|---|---|---|---|
| IP25370711P | IL | MD | Developmental Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Building Blocks Group, Inc. | Developmental Therapist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Developmental Therapist
- Park Ridge, IL
- NPI 1831687011
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1316476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1524528000000",
"number": "1790068443",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1208 ELM ST",
"city": "PARK RIDGE",
"state": "IL",
"postal_code": "600683368",
"telephone_number": "224-592-5862",
"fax_number": "888-491-5663"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1208 ELM ST",
"city": "PARK RIDGE",
"state": "IL",
"postal_code": "600683368",
"telephone_number": "224-592-5862",
"fax_number": "888-491-5663"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DI MINERVINO",
"first_name": "IRENE",
"credential": "DT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-09-20",
"last_updated": "2018-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": "IL",
"license": "IP25370711P",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Park Ridge, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 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.