Active NPI
Mark C Schodrof, PT
- Physical Therapist
- Seymour, IN
National Provider Identifier
1891896205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05010558A
- Practice address
- 200 S Obrien St
Seymour, IN 47274-2440 - Phone
- (812) 522-9574
- Fax
- (812) 522-2576
- NPI assigned
- Sep 26, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070013101 | IL | |
| Physical Therapist | 225100000X | 05010558A | IN | Primary |
Addresses
Primary practice location
200 S Obrien St
Seymour, IN 47274-2440
Mailing address
790 Remington Blvd
Bolingbrook, IL 60440-4909
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 201038240 | Medicaid | IN | |
| P00943146 | Other | IL | MEDICARE RAILROAD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070013101 | IL | MD | Physical Therapist |
| 05010558A | IN | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Athletic &Therapeutic Institute of Naperville, LLC | Physical Therapist | Past | Accepting new patients |
| Athletic and Therapeutic Institute of Joliet LLC | 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 and National Provider Directory roles.
-
- Physical Therapist
- Joliet, IL
- NPI 1598872921
-
- Physical Therapist
- Joliet, IL
- NPI 1932249109
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470960000000",
"number": "1891896205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "790 REMINGTON BLVD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604404909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 S OBRIEN ST",
"city": "SEYMOUR",
"state": "IN",
"postal_code": "472742440",
"telephone_number": "812-522-9574",
"fax_number": "812-522-2576"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCHODROF",
"first_name": "MARK",
"middle_name": "C",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-26",
"last_updated": "2016-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": "070013101",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05010558A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "201038240",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "P00943146",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Seymour, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.