DR. KETAN R MODY (NPI# 1659562585) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659562585 |
| Entity Type | Individual |
| Full Name | DR. KETAN R MODY |
| Credential | M.D. |
| Practice Address |
760 Pasquinelli Dr Ste 304 Westmont IL 60559-1290 |
| Mailing Address |
Po Box 3231 Oak Brook IL 60522-3231 |
| Practice Telephone | 6307893764 |
| Practice Fax Number | 6302062490 |
| Mailing Telephone | 6307893764 |
| Mailing Fax Number | 6307949998 |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2019-06-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207QS0010X |
Family Medicine Specialization: Sports Medicine |
036119306 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | MEDICARE INDIVIDUAL PTAN | IL2367001 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 2077 N Clybourn Ave, Chicago, IL 606144003 | 6307893764 |
| Street Address |
760 PASQUINELLI DR STE 304 |
| City | WESTMONT |
| State | IL |
| Zip Code | 60559-1290 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598366874 | Rachel Stoffregen | Physical Therapist | 812 East Ogden Ave, Westmont, IL 60559 | 2020-11-04 |
| 1528672581 | Kera C Evans | Counselor | 414 Plaza Dr. Suite 301, Westmont, IL 60559 | 2020-09-06 |
| 1912403023 | Bianca J Dassinger | Social Worker | 750 Pasquinelli Drive, #204, Westmont, IL 60559 | 2018-04-05 |
| 1689192163 | Jeannie Marie Gorman | Nutritionist | 310 W. Burlington Ave, Westmont, IL 60559 | 2017-09-05 |
| 1326563248 | Bethany Juby | Psychologist | 825 N Cass Ave Ste 112, Westmont, IL 60559 | 2017-08-11 |
| 1861917189 | Marisa Raineri | Physical Therapist | 750 Pasquinelli Dr., #204, Westmont, IL 60559 | 2017-08-08 |
| 1093185209 | Kristin Kalivoda | Pharmacy Technician | 2 N. Cass Avenue, Westmont, IL 60559 | 2015-09-30 |
| 1780076679 | Katherine Celine Smith | Nurse Practitioner | 1010 Executive Drive, Suite 200, Westmont, IL 60559 | 2015-03-02 |
| 1841690898 | Kimberly Libby | Physical Therapist | 801 N Cass Ave Ste 100, Westmont, IL 60559 | 2014-08-27 |
| 1083036792 | Deborah Carsten | Counselor | 460 Quail Ridge Drive, Westmont, IL 60559 | 2014-01-15 |
| Find all providers in zip 60559 | ||||
| Taxonomy Code | 207QS0010X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Specialization | Sports Medicine |
| A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Family Medicine, 2007. http://www.theabfm.org/. American Osteopathic Board of Family Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467687806 | Elite Sports Medicine Institute, Ltd. | Family Medicine | 760 Pasquinelli Dr, Suite 304, Westmont, IL 60559-5564 | 2009-05-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164817334 | Shachi Pandya | Family Medicine | 18350 Kedzie Ave Ste 101, Homewood, IL 60430 | 2015-04-03 |
| 1821438185 | Marianne Hana | Family Medicine | 60 Orland Square Dr Ste 101, Orland Park, IL 60462 | 2013-07-01 |
| 1376894501 | Rush-copley Medical Group | Family Medicine | 2040 Ogden Ave., Suite 304, Aurora, IL 60504 | 2012-09-27 |
| 1144495961 | Karsten B Slater | Family Medicine | 1527 College Dr, Mount Carmel, IL 62863 | 2008-04-23 |
| 1104000561 | Competitive Edge Sports Medicine | Family Medicine | 14160 Jamestown Rd, Breese, IL 62230 | 2007-12-20 |
| 1477734150 | Sashil Singh Kapur | Family Medicine | 415 N Lasalle Street, Suite 100, Chicago, IL 60654 | 2007-11-21 |
| 1285841544 | Arthur Aragones | Family Medicine | 135 E Irving Park Rd, Streamwood, IL 60107-2950 | 2007-05-17 |
| 1003028150 | Jill Wirth-rissman | Family Medicine | 205 N Cummings Ln, Washington, IL 61571-2181 | 2007-05-03 |
| 1497838676 | Christopher Eric Cieurzo | Family Medicine | 510 Pow Mia St Bldg P40, Scott Afb, IL 62225-5020 | 2006-10-23 |
| 1699861682 | Lawrence Timothy Kacmar | Family Medicine | 3965 75th St, Suite 103, Aurora, IL 60504-7925 | 2006-10-05 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.