Roger Fong, MPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070013559 Issued in IL

Practice address

4835 S Langley Ave
Chicago, IL 60615-1515

Phone

(312) 403-1853

NPI assigned

Jul 3, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Bodhi & Sage, LLC

  • Physical Therapy Clinic/Center
  • Chicago, IL
  • NPI 1538534359

  Acupuncturist

  Medicare reassignment NPD Authorized official
• Bodhi & Sage, LLC

  • Acupuncturist
  • Chicago, IL
  • NPI 1902391360
  NPD Authorized official

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

{
    "created_epoch": "1341273600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698624000000",
    "number": "1821352915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 E 53RD ST STE 814",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606154572",
            "telephone_number": "312-403-1853",
            "fax_number": "773-947-0084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4835 S LANGLEY AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606151515",
            "telephone_number": "312-403-1853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONG",
        "first_name": "ROGER",
        "name_prefix": "Mr.",
        "credential": "MPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-07-03",
        "last_updated": "2023-10-30",
        "certification_date": "2023-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "IL",
            "license": "198001289",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070013559",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tracy Fondren-Lusk
• Brian Fondren, FNP-C
• Nia Denise Foney
• Michal Fonfa, SLP
• Robert Fong II, MD, PHD
• Verissa Lam Fong, O.D.
• Vicki K Fong, RPH
• Camille Arianne Fonseca, MD,MPH
• Luvianca J. Fonseca, M.D.
• Anika Fonson

• Physical Therapist in Chicago, IL
• Providers in Chicago, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2023; 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.