NPIMap

Organization Active NPI

Ortho-Sport, Inc.

  • Physical Therapist
  • Forest Park, IL
National Provider Identifier
1942379110
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
ORTHO-SPORT, INC.
Practice address
800 Des Plaines Ave
Forest Park, IL 60130-2035
Phone
(708) 366-2442
Fax
(708) 366-0179
NPI assigned
Nov 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Michael Edward Keenum, PT
Title
Owner President
Phone
(708) 366-2442

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X IL Primary

Addresses

Primary practice location

800 Des Plaines Ave
Forest Park, IL 60130-2035

Mailing address

800 Des Plaines Ave
Forest Park, IL 60130-2035
Phone (708) 366-2442

Other identifiers 1

IdentifierTypeStateIssuer
1683317OtherILBCBS OF IL

National Provider Directory

National Provider Directory

Locations

2121 W Indian Trl
Aurora, IL 60506
Phone (630) 907-9012

7511 Lemont Rd
Ste 204
Darien, IL 60561
Phone (630) 985-4010

1935 95th St
Unit 114
Naperville, IL 60564
Phone (708) 366-2442

2480 US Highway 30
Oswego, IL 60543
Phone (708) 366-2442

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1942379110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 DES PLAINES AVE",
            "city": "FOREST PARK",
            "state": "IL",
            "postal_code": "601302035",
            "telephone_number": "708-366-2442",
            "fax_number": "708-366-0179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 DES PLAINES AVE",
            "city": "FOREST PARK",
            "state": "IL",
            "postal_code": "601302035",
            "telephone_number": "708-366-2442",
            "fax_number": "708-366-0179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHO-SPORT, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KEENUM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "708-366-2442",
        "authorized_official_credential": "PT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF IL",
            "identifier": "1683317",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest Park, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.