Jacob Smith

Primary specialty

Physical TherapistTaxonomy code 225100000X

Practice address

3381 W Main St Ste 1
Saint Charles, IL 60175-1008

Phone

(630) 649-0511

NPI assigned

Aug 3, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Midwestern University, Chicago College of Osteopathic Med, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Legacy Physical Therapy and Wellness PLLCGroup PAC ID 4981055852, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Legacy Physical Therapy and Wellness PLLC

  • Physical Therapy Clinic/Center
  • Naperville, IL
  • NPI 1992585095
  Medicare reassignment Care Compare group NPD
• Fox Valley Physical Therapy and Wellness,LLC

  • Physical Therapist
  • Saint Charles, IL
  • NPI 1619288966
  Medicare reassignment NPD
• Legacy Physical Therapy and Wellness PLLC

  • Physical Therapist
  • Plainfield, IL
  • NPI 1043199607
  NPD
• Wisconsin Orthopedic Physical Therapy

  • Physical Therapist
  • Hartland, WI
  • NPI 1285478743
  NPD (past)

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

{
    "created_epoch": "1722643200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722643200000",
    "number": "1821828013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2499 FOX DR",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605066412",
            "telephone_number": "630-715-0144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3381 W MAIN ST STE 1",
            "city": "SAINT CHARLES",
            "state": "IL",
            "postal_code": "601751008",
            "telephone_number": "630-649-0511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "JACOB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-03",
        "last_updated": "2024-08-03",
        "certification_date": "2024-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Margaret Slavich, PSY.D.
• Lynsey M Sloan, LCSW
• Danielle Slyder, LCPC, ATR
• Debra Smalley, PA-C
• Smiles4U
• Jessica Davenport Smith, D.C.
• Kam Smith, LPN
• Kimberly Anne Smith
• Kyle James Smith, LCPC, NCC
• Lauren Smith

• Physical Therapist in Saint Charles, IL
• Providers in Saint Charles, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2024; 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.