Bodhi & Sage, LLC

Primary specialty

AcupuncturistTaxonomy code 171100000X

License

198001289 Issued in IL

Legal business name

BODHI & SAGE, LLC

Practice address

1525 E 53Rd St Ste 808
Chicago, IL 60615-4583

Phone

(312) 403-1853

Fax

(773) 947-0084

NPI assigned

Jun 28, 2018

Organization subpart

No

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

Authorized official

Name

Roger Fong, PT, LACNPI 1821352915

Title

Founder & Clinic Director

Phone

(312) 403-1853

Specialties & licenses 1

Addresses

Tax ID family

Bodhi Sage LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Bodhi & Sage, LLC

  • Physical Therapy Clinic/Center
  • Chicago, IL
  • NPI 1538534359
  NPD tax ID

Locations

Practitioners 1

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

• Roger Fong, MPT

  • Physical Therapist
  • Chicago, IL
  • NPI 1821352915

  Acupuncturist

  NPD Authorized official

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

{
    "created_epoch": "1530144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530144000000",
    "number": "1902391360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1525 E 53RD ST STE 808",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606154583",
            "telephone_number": "312-403-1853",
            "fax_number": "773-947-0084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 E 53RD ST STE 808",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606154583",
            "telephone_number": "312-403-1853",
            "fax_number": "773-947-0084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BODHI & SAGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-28",
        "last_updated": "2018-06-28",
        "status": "A",
        "authorized_official_last_name": "FONG",
        "authorized_official_first_name": "ROGER",
        "authorized_official_title_or_position": "FOUNDER & CLINIC DIRECTOR",
        "authorized_official_telephone_number": "312-403-1853",
        "authorized_official_credential": "PT, LAC"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Acupuncturist",
            "state": "IL",
            "license": "198001289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Philip Charles Bodenstab Jr., MD
• Anne Bodenstine, PT
• Alaya Bodepudi, MD
• Matthew Ryan Bodett
• Bodhi & Sage, LLC
• Bodhi Tree Center for Holistic Therapy LLC
• Bodi by Me Med Spa LLC
• Christine Heidi Anne Bodine, MD
• Brittany Bodkin, LCSW
• Nicholas Leon Bodkin

• Acupuncturist in Chicago, IL
• Providers in Chicago, IL by specialty
• Acupuncturist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.