Individual provider Active NPI

Molly R Gill, PT

  • Physical Therapist
  • Bloomington, IL
National Provider Identifier
1831692219
Registry record updated Aug 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070025416 Issued in IL
Practice address
2103 N Veterans Pkwy Ste 332
Bloomington, IL 61704-0917
Phone
(309) 585-1809
NPI assigned
Mar 13, 2018
Last updated
Aug 26, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2020

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 070025416 IL Primary

Addresses

Primary practice location

2103 N Veterans Pkwy Ste 332
Bloomington, IL 61704-0917

Mailing address

1377 Motor Pkwy Ste 307
Islandia, NY 11749-5258
Phone (631) 580-5200

Other practice location 1

3263 Eaton Rd
Green Bay, WI 54311-6830
Phone (920) 433-6700

Other practice location 2

720 S VanBuren St
Green Bay, WI 54301-3504
Phone (920) 433-3420

Other practice location 3

744 S Webster Ave
Green Bay, WI 54301-3505
Phone (920) 433-7822

Other practice location 4

1630 Commanche Ave
Green Bay, WI 54313-5753
Phone (920) 430-4750

Other identifiers 1

IdentifierTypeStateIssuer
070025416OtherILSTATE LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180419001689 WI Practitioner - Physical Therapist in Private Practice 7618230996 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1 Bank Ave
Suite C
Kaukauna, WI 54130-2582
Phone (920) 759-9075

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070025416ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Bellin Memorial Hospital Inc Physical Therapist CurrentSince Mar 16, 2018 Accepting new patients
Bellin Memorial Hospital, Inc CurrentSince Mar 16, 2018 Accepting new patients
Bellin Memorial Hospital Inc Current Accepting new patients
Orthopedic and Spine Therapy of Menasha SC Physical Therapist Current Accepting new patients
Orthopedic & Spine Therapy of Menasha SC Physical Therapist CurrentSince May 10, 2023 Accepting new patients
Orthopedic & Spine Therapy of Menasha SC Physical Therapist Past Accepting new patients
Bellin Psychiatric Center Inc. Past Accepting new patients

Locations

4000 N Providence Ave
Appleton, WI 54913
Phone (920) 257-2000

1630 Commanche Ave
Green Bay, WI 54313
Phone (920) 430-4700

2305 San Luis Pl
Green Bay, WI 54304
Phone (920) 494-2817

3263 Eaton Rd
Green Bay, WI 54311
Phone (920) 433-6000

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

1 Bank Ave
Ste C
Kaukauna, WI 54130
Phone (920) 759-9075

1000 Midway Rd
Menasha, WI 54952
Phone (920) 257-2000

Organizations & group practices 8

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": "1520899200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598400000000",
    "number": "1831692219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1377 MOTOR PKWY STE 307",
            "city": "ISLANDIA",
            "state": "NY",
            "postal_code": "117495258",
            "telephone_number": "631-580-5200",
            "fax_number": "631-824-9335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2103 N VETERANS PKWY STE 332",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617040917",
            "telephone_number": "309-585-1809"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3263 Eaton Rd",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543116830",
            "country_code": "US",
            "telephone_number": "920-433-6700",
            "fax_number": "920-433-6719",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "720 S VanBuren St",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543013504",
            "country_code": "US",
            "telephone_number": "920-433-3420",
            "fax_number": "920-433-3788",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "744 S Webster Ave",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543013505",
            "country_code": "US",
            "telephone_number": "920-433-7822",
            "fax_number": "920-433-3651",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1630 Commanche Ave",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543135753",
            "country_code": "US",
            "telephone_number": "920-430-4750",
            "fax_number": "920-430-4746",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GILL",
        "first_name": "MOLLY",
        "middle_name": "R",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-13",
        "last_updated": "2020-08-26",
        "certification_date": "2020-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070025416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "070025416",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2020; 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.