{
"Npi": {
"NPI": "1023062601",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "REHABILITATION MEDICINE CLINIC, INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "26W171 ROOSEVELT RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WHEATON",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60187-6078",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "630-588-7891",
"MailingAddressFaxNumber": "630-462-5573",
"FirstLinePracticeLocationAddress": "26W171 ROOSEVELT RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WHEATON",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "60187-6078",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "630-588-7891",
"PracticeLocationAddressFaxNumber": "630-462-5573",
"EnumerationDate": "05/19/2006",
"LastUpdateDate": "09/11/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SERPICO",
"AuthorizedOfficialFirstName": "DOMINIC",
"AuthorizedOfficialMiddleName": "MARTIN",
"AuthorizedOfficialTitle": "DIRECTOR, FINANCE",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": "JR.",
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "630-588-7891",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QR0400X",
"TaxonomyName": "Rehabilitation Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "261QM1300X",
"TaxonomyName": "Multi-Specialty Clinic/Center",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}