Active NPI
Jason Roosevelt Brusa
- Recreation Therapist
- Chicago, IL
National Provider Identifier
1922728047
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Recreation Therapist
- License
- 56129
- Practice address
- 820 S Damen Ave
Chicago, IL 60612-3728 - Phone
- (312) 569-9502
- NPI assigned
- Aug 30, 2022
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Recreation Therapist | 225800000X | 56129 | IL | Primary |
Addresses
Primary practice location
820 S Damen Ave
Chicago, IL 60612-3728
Mailing address
902 Clement St
Joliet, IL 60435-4615
Phone (630) 698-0214
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 56129 | IL | MD | Recreation Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1661817600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1661817600000",
"number": "1922728047",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "902 CLEMENT ST",
"city": "JOLIET",
"state": "IL",
"postal_code": "604354615",
"telephone_number": "630-698-0214"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "820 S DAMEN AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123728",
"telephone_number": "312-569-9502"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUSA",
"first_name": "JASON",
"middle_name": "ROOSEVELT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-08-30",
"last_updated": "2022-08-30",
"certification_date": "2022-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "225800000X",
"taxonomy_group": "",
"desc": "Recreation Therapist",
"state": "IL",
"license": "56129",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.