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NPI
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1477602373
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10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider.
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Entity Type
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Organization
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Code describing the type of health care provider that is being assigned an NPI. Codes are:
- 1 = (Person): individual human being who furnishes health care;
- 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
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Provider Organization Name (Legal Business Name)
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PEDIATRIC WELLNESS
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Provide organization name (legal business name used to file tax returns with the IRS). The Organization Name field allows the following special characters: ampersand, apostrophe, "at" sign, colon, comma, forward slash, hyphen, left and right parentheses, period, pound sign, quotation mark, and semi-colon. A field cannot contain all special characters.
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Provider First Line Business Mailing Address
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236 WESTBROOK CIR
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The first line mailing address of the provider being identified. This data element may contain the same information as ''Provider first line location address''.
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Provider Business Mailing Address City Name
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NAPERVILLE
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The City name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address City name''.
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Provider Business Mailing Address State Name
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IL
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The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address State name''.
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Provider Business Mailing Address Postal Code
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60565-3269
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The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ''Provider location address postal code''.
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Provider Business Mailing Address Country Code
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US
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The country code in the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address country code''.
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Provider Business Mailing Address Telephone Number
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630-548-2520
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The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ''Provider location address telephone number''.
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Provider Business Mailing Address Fax Number
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630-548-2512
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The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ''Provider location address fax number''.
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Provider First Line Business Practice Location Address
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236 WESTBROOK CIR
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The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
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Provider Business Practice Location Address City Name
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NAPERVILLE
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The city name in the location address of the provider being identified.
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Provider Business Practice Location Address State Name
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IL
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The State or Province name in the location address of the provider being identified.
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Provider Business Practice Location Address Postal Code
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60565-3269
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The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
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Provider Business Practice Location Address Country Code
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US
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The country code in the location address of the provider being identified.
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Provider Business Practice Location Address Telephone Number
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630-548-2520
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The telephone number associated with the location address of the provider being identified.
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Provider Business Practice Location Address Fax Number
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630-548-2512
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The fax number associated with the location address of the provider being identified.
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Provider Enumeration Date
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01/09/2007
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The date the provider was assigned a unique identifier (assigned an NPI).
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Last Update Date
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07/08/2007
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The date that a record was last updated or changed.
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Authorized Official Last Name
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ROAT
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The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
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Authorized Official First Name
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TERRY
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The first name of the authorized official
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Authorized Official Title or Position
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OWNER
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The title or position of the authorized official
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Authorized Official Name Prefix Text
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MS.
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Authorized Official Name Prefix Text
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Authorized Official Credential Text
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OTR
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Authorized Official Credential Text
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Authorized Official Telephone Number
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630-548-2520
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The 10-position telephone number of the authorized official.
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Healthcare Provider Taxonomy Code #1
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224Z00000X
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The Health Care Provider Taxonomy code is a unique alphanumeric code, ten characters in length. The code set is structured into three distinct "Levels" including Provider Type, Classification, and Area of Specialization.
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Healthcare Provider Taxonomy 1
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Occupational Therapy Assistant
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Healthcare Provider Taxonomy #1
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Provider License Number State Code 1
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IL
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Provider License Number State Code #1
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Healthcare Provider Primary Taxonomy Switch 1
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X
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Primary Taxonomy:
- X - The primary taxonomy switch is Not Answered;
- Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
- N - The taxonomy is not the primary taxonomy.
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Healthcare Provider Taxonomy Code 2
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225100000X
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Healthcare Provider Taxonomy Code #2
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Healthcare Provider Taxonomy 2
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Physical Therapist
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Healthcare Provider Taxonomy #2
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Provider License Number State Code 2
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IL
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Provider License Number State Code #2
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Healthcare Provider Primary Taxonomy Switch 2
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X
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Primary Taxonomy:
- X - The primary taxonomy switch is Not Answered;
- Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
- N - The taxonomy is not the primary taxonomy.
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Healthcare Provider Taxonomy Code 3
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225X00000X
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Healthcare Provider Taxonomy Code #3
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Healthcare Provider Taxonomy 3
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Occupational Therapist
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Healthcare Provider Taxonomy #3
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Provider License Number State Code 3
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IL
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Provider License Number State Code #3
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Healthcare Provider Primary Taxonomy Switch 3
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X
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Primary Taxonomy:
- X - The primary taxonomy switch is Not Answered;
- Y - The taxonomy is the primary taxonomy (there can be only one per NPI record);
- N - The taxonomy is not the primary taxonomy.
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Healthcare Provider Taxonomy Group 1
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193200000X MULTI-SPECIALTY GROUP
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Healthcare Provider Taxonomy Group 1
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Healthcare Provider Taxonomy Group Description 1
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Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization.
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Healthcare Provider Taxonomy Group Description 1
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Healthcare Provider Taxonomy Group 2
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193200000X MULTI-SPECIALTY GROUP
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Healthcare Provider Taxonomy Group 2
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Healthcare Provider Taxonomy Group Description 2
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Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization.
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Healthcare Provider Taxonomy Group Description 2
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Healthcare Provider Taxonomy Group 3
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193200000X MULTI-SPECIALTY GROUP
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Healthcare Provider Taxonomy Group 3
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Healthcare Provider Taxonomy Group Description 3
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Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization.
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Healthcare Provider Taxonomy Group Description 3
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