Individual provider Active NPI

Jason T. Grandone, PT

  • Physical Therapist
  • Galesburg, IL
National Provider Identifier
1982603502
Registry record updated Apr 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070010049 Issued in IL
Practice address
765 N Kellogg St
Galesburg, IL 61401-2875
Phone
(309) 343-3434
Fax
(309) 343-3456
NPI assigned
Jul 15, 2005
Last updated
Apr 20, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070010049 IL Primary

Addresses

Primary practice location

765 N Kellogg St
Galesburg, IL 61401-2875

Mailing address

765 N Kellogg St
Galesburg, IL 61401-2871
Phone (309) 343-3434

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130809000409 IL Practitioner - Physical Therapist in Private Practice 7517136823 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Apex Physical Therapy, LLCGroup PAC ID 2264423458, 104 clinicians

Practice addresses (Care Compare)

15 Apex Dr
Highland, IL 62249-1282
Phone (618) 651-0444

Merit-based Incentive Payment System (MIPS)

Final score
76.03 of 100Reported as group
Quality
74.47
Improvement activities
40
Cost
66.89

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070010049ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Apex Physical Therapy, LLC Physical Therapist CurrentSince Jul 1, 2013 Accepting new patients
Midwest PCW PT, LLC Physical Therapist CurrentSince Oct 1, 2017 Accepting new patients
Apex Physical Therapy, LLC Physical Therapist CurrentSince Jul 1, 2013 Accepting new patients
Apex Physical Therapy, LLC Physical Therapist PastSince Jul 1, 2013 Accepting new patients

Locations

538 Mason Dr
Breese, IL 62230
Phone (618) 623-0580

4280 S State Route 159
Ste 3
Glen Carbon, IL 62034
Phone (618) 288-4233

4955 S State Route 159
Ste B
Glen Carbon, IL 62034
Phone (618) 288-4677

15 Apex Dr
Highland, IL 62249
Phone (618) 441-0482

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1121385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303257600000",
    "number": "1982603502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "765 N KELLOGG ST",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614012871",
            "telephone_number": "309-343-3434",
            "fax_number": "309-343-3456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "765 N KELLOGG ST",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614012875",
            "telephone_number": "309-343-3434",
            "fax_number": "309-343-3456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANDONE",
        "first_name": "JASON",
        "middle_name": "T.",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-15",
        "last_updated": "2011-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070010049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Galesburg, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.