Individual provider Active NPI

Mary Gretchen O Connor, PT

  • Geriatric Physical Therapist
  • Grayslake, IL
National Provider Identifier
1861941346
Registry record updated Oct 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Physical TherapistTaxonomy code 2251G0304X
License
070.019894 Issued in IL
Practice address
997 N Corporate Cir
Grayslake, IL 60030-7822
Phone
(847) 223-8001
NPI assigned
Sep 26, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Physical Therapist 2251G0304X 070.019894 IL Primary

Addresses

Primary practice location

997 N Corporate Cir
Grayslake, IL 60030-7822

Mailing address

997 N Corporate Cir
Grayslake, IL 60030-7822
Phone (847) 223-8001

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161024001484 IL Practitioner - Physical Therapist in Private Practice 7012295272 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

997 N Corporate Cir
Suite B
Grayslake, IL 60030-7822
Phone (847) 223-8001

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Grayslake Rehabilitation and Complete Physical Therapy LLC Geriatrics CurrentSince Oct 3, 2016 Accepting new patients
Caitlin Chandran MSN, Aprn-Fpa, FNP-BC PLLC CurrentSince Oct 11, 2022 Accepting new patients

Locations

997 N Corporate Cir
Ste B
Grayslake, IL 60030
Phone (847) 223-8001

997 N Corporate Cir
Grayslake, IL 60030
Phone (847) 223-8001

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1474848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475452800000",
    "number": "1861941346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "997 N CORPORATE CIR",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600307822",
            "telephone_number": "847-223-8001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "997 N CORPORATE CIR",
            "city": "GRAYSLAKE",
            "state": "IL",
            "postal_code": "600307822",
            "telephone_number": "847-223-8001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O CONNOR",
        "first_name": "MARY",
        "middle_name": "GRETCHEN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-26",
        "last_updated": "2016-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "IL",
            "license": "070.019894",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grayslake, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2016; 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.