Active NPI
Broadleaf Health and Wellness
- Multi-Specialty Clinic/Center
- Berwyn, IL
National Provider Identifier
1932700770
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Multi-Specialty Clinic/Center
- Legal business name
- BROADLEAF HEALTH AND WELLNESS
- Doing business as
- Broadleaf Health and Wellness
- Practice address
- 3245 Grove Ave Ste 205
Berwyn, IL 60402-3476 - Phone
- (773) 947-4607
- NPI assigned
- Nov 6, 2020
- Last updated
- Nov 11, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Maria Espejo, OT/CCCPA
- Title
- Rehab Practitioner
- Phone
- (773) 947-4607
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Physical Medicine & Rehabilitation) Physician | 2081S0010X | |||
| Multi-Specialty Clinic/Center | 261QM1300X | Primary | ||
| Rehabilitation Chiropractor | 111NR0400X |
Addresses
Primary practice location
3245 Grove Ave Ste 205
Berwyn, IL 60402-3476
Mailing address
3245 Grove Ave Ste 205
Berwyn, IL 60402-3476
Phone (773) 947-4607
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00 | Other | PERSONAL INSURANCE | |
| 00 | Medicaid | IL |
Other names 1
- Broadleaf Health and Wellness
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | office | Direct | |
| CONNECT URL | direct | Direct |
National Provider Directory
National Provider Directory- Tax ID family
- Broadleaf Health and Wellness
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Specialist
- Berwyn, IL
- NPI 1316477938
-
- Health Service Clinic/Center
- Berwyn, IL
- NPI 1326641986
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Cardiology Technician
- Darien, IL
- NPI 1821525403
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1604620800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1731283200000",
"number": "1932700770",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3245 GROVE AVE STE 205",
"city": "BERWYN",
"state": "IL",
"postal_code": "604023476",
"telephone_number": "773-947-4607"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3245 GROVE AVE STE 205",
"city": "BERWYN",
"state": "IL",
"postal_code": "604023476",
"telephone_number": "773-947-4607"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BROADLEAF HEALTH AND WELLNESS",
"organizational_subpart": "NO",
"enumeration_date": "2020-11-06",
"last_updated": "2024-11-11",
"certification_date": "2024-11-11",
"status": "A",
"authorized_official_last_name": "ESPEJO",
"authorized_official_first_name": "MARIA",
"authorized_official_title_or_position": "REHAB PRACTITIONER",
"authorized_official_telephone_number": "773-947-4607",
"authorized_official_credential": "OT/CCCPA"
},
"taxonomies": [
{
"code": "2081S0010X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation, Sports Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QM1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Multi-Specialty",
"state": null,
"license": null,
"primary": true
},
{
"code": "111NR0400X",
"taxonomy_group": "",
"desc": "Chiropractor, Rehabilitation",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PERSONAL INSURANCE",
"identifier": "00",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00",
"state": "IL"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "office",
"affiliation": "N",
"endpointDescription": "information",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "direct",
"address_1": "3245 Grove Ave Ste 205",
"city": "Berwyn",
"state": "IL",
"country_code": "US",
"postal_code": "604023476",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "direct",
"affiliation": "N",
"endpointDescription": "information",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "3245 Grove Ave Ste 205",
"city": "Berwyn",
"state": "IL",
"country_code": "US",
"postal_code": "604023476",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "Broadleaf Health and Wellness",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Broadleaf Health and Wellness",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Berwyn, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.