CMS-1500 Box 24J / 33a • NPI
1235121393
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
225100000X (CMS 65)
Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist
Box 32 Service Location & ZIP+4
1201 E BROADWAY, SUITE C, MONMOUTH, IL, 61462-1994
✓ 9-Digit EDI 837 ZIP+4 (61462-1994)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1235121393 (ADVANCED REHAB SPORTS MEDICINE) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1235121393 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | ADVANCED REHAB SPORTS MEDICINE |
| Plain-English Specialty | Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist NUCC Code: 225100000X (Physical Therapist) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 1201 E BROADWAY, SUITE C, MONMOUTH, IL, 61462-1994 |
| Practice Telephone / Fax | Tel: (309) 734-1103 | Fax: (309) 734-2013 |
| Administrative Mailing Address | PO BOX 5387, BLOOMINGTON, IL, 61702-5387 |
| Enumeration & Last Sync | Enumerated: 2005-08-16 | CMS Record Updated: 2022-11-03 |
| Authorized Official | MARK OERTWIG (Director of Finance) |
Clinic Location, Accessibility & Directions
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Plain-English Taxonomy & CMS Crosswalk (225100000X)
What Does Taxonomy Code 225100000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 225100000X translates to:
"Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (ADVANCED REHAB SPORTS MEDICINE)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
225X00000X — Occupational TherapistPlain English: Board-Certified Occupational Therapist (OTR/L — Functional & Daily Living Rehab) | State: IL | License: Verified | Primary: Secondary |
235Z00000X — Speech-Language Pathologist, Plain English: Licensed & Credentialed Speech, Language and Hearing Service Providers | State: IL | License: Verified | Primary: Secondary |
225100000X — Physical TherapistPlain English: Licensed & Credentialed Respiratory, Developmental, Rehabilitative & Restorative Service Providers — Physical Therapist | State: IL | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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