Individual provider Active NPI

Amy Jean Summers, P.T.

  • Physical Therapist
  • Shelbyville, IL
National Provider Identifier
1790752178
Registry record updated Mar 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070.016443 Issued in IL
Practice address
2100 W South 3Rd Street
Shelbyville, IL 62565
Phone
(217) 774-9660
Fax
(214) 774-9661
NPI assigned
Mar 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070.016443 IL Primary

Addresses

Primary practice location

2100 W South 3Rd Street
Shelbyville, IL 62565

Mailing address

2173 County Highway 7
Shelbyville, IL 62565-4172
Phone (270) 205-9724

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100303000179 IL Practitioner - Physical Therapist in Private Practice 0840335709 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Saint Louis University School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Phoenix Physical TherapyGroup PAC ID 5991861049, 7 clinicians

Practice addresses (Care Compare)

2100 W S 3Rd St
Shelbyville, IL 62565
Phone (217) 774-9660

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070.016443ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Phoenix Physical Therapy Physical Therapist CurrentSince Mar 17, 2014 Accepting new patients
Vandalia Physical Therapy LTD Physical Therapist Past Accepting new patients
Biokinetics Inc. Physical Therapist Past Accepting new patients
Biokinetics, Inc PastSince Aug 6, 2014 Accepting new patients

Locations

610 E City Route 40
Greenville, IL 62246
Phone (618) 258-9093

7 Emerald Ter
Swansea, IL 62226
Phone (618) 235-0700

126 S 1st St
Vandalia, IL 62471
Phone (618) 283-1634

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1141344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395187200000",
    "number": "1790752178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2173 COUNTY HIGHWAY 7",
            "city": "SHELBYVILLE",
            "state": "IL",
            "postal_code": "625654172",
            "telephone_number": "270-205-9724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 W SOUTH 3RD STREET",
            "city": "SHELBYVILLE",
            "state": "IL",
            "postal_code": "62565",
            "telephone_number": "217-774-9660",
            "fax_number": "214-774-9661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUMMERS",
        "first_name": "AMY",
        "middle_name": "JEAN",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-03",
        "last_updated": "2014-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.016443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Shelbyville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.