NPIMap

Organization Active NPI

Chicago Health and Physical Therapy Center SC

  • Clinic/Center
  • Chicago, IL
National Provider Identifier
1861421950
Registry record updated Jul 30, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
042.618903 Issued in IL
Legal business name
CHICAGO HEALTH AND PHYSICAL THERAPY CENTER SC
Practice address
5545 W Montrose Ave
Chicago, IL 60641-1331
Phone
(773) 282-6648
Fax
(773) 282-6965
NPI assigned
Jul 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2019

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

Authorized official

Name
Dr. Richard J Dietzen, DCNPI 1376581116
Title
Director
Phone
(773) 282-6648

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 042.618903 IL Primary

Addresses

Primary practice location

5545 W Montrose Ave
Chicago, IL 60641-1331

Mailing address

5545 W Montrose Ave
Chicago, IL 60641-1331
Phone (773) 282-6648

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060822000028 IL Part B Supplier - Clinic/Group Practice 3870596455 Receives reassigned benefits from 10 practitioners
Practice locations: Chicago, IL

National Provider Directory

National Provider Directory

Locations

5545 W Montrose Ave
Chicago, IL 60641
Phone (773) 282-6648

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564444800000",
    "number": "1861421950",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5545 W MONTROSE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606411331",
            "telephone_number": "773-282-6648",
            "fax_number": "773-282-6965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5545 W MONTROSE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606411331",
            "telephone_number": "773-282-6648",
            "fax_number": "773-282-6965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHICAGO HEALTH AND PHYSICAL THERAPY CENTER SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-01",
        "last_updated": "2019-07-30",
        "status": "A",
        "authorized_official_last_name": "DIETZEN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "773-282-6648",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": "042.618903",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.