Individual provider Active NPI

Todd A. Vanatta, P.T.

  • Physical Therapist
  • Dekalb, IL
National Provider Identifier
1881994721
Registry record updated Apr 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070-014567 Issued in IL
Practice address
3266 Sycamore Rd
Dekalb, IL 60115-9621
Phone
(815) 756-8524
Fax
(815) 756-1841
NPI assigned
Oct 26, 2010
Last updated
Apr 26, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2017

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 070-014567 IL Primary

Addresses

Primary practice location

3266 Sycamore Rd
Dekalb, IL 60115-9621

Mailing address

3266 Sycamore Rd
Dekalb, IL 60115-9621
Phone (815) 756-8524

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101207000065 IL Practitioner - Physical Therapist in Private Practice 3779770516 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3266 Sycamore Rd
Dekalb, IL 60115-9621
Phone (815) 756-8524

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070-014567ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Rehabilitation and Sports Medicine Associates Physical Therapist Past Accepting new patients

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, 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": "1288051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1493164800000",
    "number": "1881994721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3266 SYCAMORE RD",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601159621",
            "telephone_number": "815-756-8524",
            "fax_number": "815-756-1841"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3266 SYCAMORE RD",
            "city": "DEKALB",
            "state": "IL",
            "postal_code": "601159621",
            "telephone_number": "815-756-8524",
            "fax_number": "815-756-1841"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANATTA",
        "first_name": "TODD",
        "middle_name": "A.",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-26",
        "last_updated": "2017-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070-014567",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dekalb, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2017; 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.