Organization Active NPI

Unlimited Potential 1 Inc.

  • Occupational Therapist
  • Niles, IL
National Provider Identifier
1861621757
Registry record updated Jul 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
UNLIMITED POTENTIAL 1 INC.
Practice address
8539 N Olcott Ave
Niles, IL 60714-2051
Phone
(847) 581-1446
Fax
(847) 983-8175
NPI assigned
Jul 13, 2009
Last updated
Jul 13, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2009

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

Authorized official

Name
Mrs. Debbie A GoleniaNPI 1356221709
Title
President
Phone
(847) 581-1446

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X
Occupational Therapist 225X00000X Primary

Addresses

Primary practice location

8539 N Olcott Ave
Niles, IL 60714-2051

Mailing address

8539 N Olcott Ave
Niles, IL 60714-2051
Phone (847) 581-1446

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100921000394 IL Part B Supplier - Clinic/Group Practice 4486779915 Receives reassigned benefits from 3 practitioners
Practice locations: Niles, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1247443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247443200000",
    "number": "1861621757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8539 N OLCOTT AVE",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607142051",
            "telephone_number": "847-581-1446",
            "fax_number": "847-983-8175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8539 N OLCOTT AVE",
            "city": "NILES",
            "state": "IL",
            "postal_code": "607142051",
            "telephone_number": "847-581-1446",
            "fax_number": "847-983-8175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNLIMITED POTENTIAL 1 INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-13",
        "last_updated": "2009-07-13",
        "status": "A",
        "authorized_official_last_name": "GOLENIA",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-581-1446",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Niles, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2009; 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.