MR. TERRY J SUPAN (NPI# 1366461410) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366461410 |
| Entity Type | Individual |
| Full Name | MR. TERRY J SUPAN |
| Credential | CPO |
| Practice Address |
355 W Carpenter Street Suite B Springfield IL 62702-4945 |
| Practice Telephone | 2177891450 |
| Practice Fax Number | 2177891454 |
| Mailing Telephone | 2177891450 |
| Mailing Fax Number | 2177891454 |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 222Z00000X | Orthotist | IL | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | |
| X | 224P00000X | Prosthetist | IL | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
355 W CARPENTER STREET SUITE B |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62702-4945 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184643231 | Daryl G Barth | Orthotist | 355 W Carpenter Street, Suite B, Springfield, IL 62702-4945 | 2006-07-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457866519 | Mohammad Jamal Uddin Ansari | Internal Medicine | 751 N Rutledge St Ste 400, Springfield, IL 62702 | 2017-12-11 |
| 1588105811 | Mickey Graphia | Surgery | 701 N 1st St # D346, Springfield, IL 62702 | 2017-03-20 |
| 1376908913 | Abdul Hannan | Internal Medicine | 315 W Carpenter St # B, Springfield, IL 62702 | 2015-12-28 |
| 1871986414 | Rachel Hoselton | Nurse Practitioner | 400 N 9th St Fl 4, Springfield, IL 62702 | 2015-03-06 |
| 1548697774 | Alyssa Wilson | Behavioral Analyst | 232 Bruns Lane, One Sparcenter Plaza, Springfield, IL 62702 | 2013-10-02 |
| 1174965446 | Amy Wilson | Speech-Language Pathologist | 2120 West Washington Street, Springfield, IL 62702 | 2013-07-26 |
| 1275898116 | Pele Boutrous Dina | Pediatrics | 415 N 9th St # 4w16, Springfield, IL 62702 | 2012-07-06 |
| 1427327733 | Brook D Croke | Genetic Counselor, MS | 400 N. 9th Street, 3rd Floor Clinic B, Springfield, IL 62702 | 2011-12-16 |
| 1629352604 | Renae M Sanchez | Pharmacist | 3216 East Clearlake Ave, Springfield, IL 62702 | 2011-10-07 |
| 1982915302 | William Leland Zelkovich | Radiology | 701 N 1st, Springfield, IL 62702 | 2010-06-30 |
| Find all providers in zip 62702 | ||||
| Taxonomy Code | 222Z00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Orthotist |
| A health care professional who is specifically educated and trained to manage comprehensive orthotic patient care, including musculoskeletal and neuromuscular anomalies resulting from injuries or disease processes involving the lower extremity, upper extremity or spinal segment/s and positional deformation of the cranium. Orthotists assess specific patient needs, formulate an appropriate treatment plan, implement the treatment plan and provide follow-up care. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326316951 | Patrick Vincent Logan | Orthotist | 426 Indian Rock Dr, Springfield, PA 19064-1926 | 2011-12-10 |
| 1710099882 | Geza F Kogler | Orthotist | 2020 W Iles, Springfield, IL 62704 | 2006-08-31 |
| 1720502750 | Mellissa Rae Frietchen | Orthotist | 1246 E Walnut Lawn St, Springfield, MO 65804-4202 | 2017-08-01 |
| 1881952992 | Jason C Mccann | Orthotist | 3003 S Kansas Expy, Springfield, MO 65807-5969 | 2012-04-26 |
| 1184643231 | Daryl G Barth | Orthotist | 355 W Carpenter Street, Suite B, Springfield, IL 62702-4945 | 2006-07-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073140414 | Phoenix Rising Prosthetic Orthotic Service Pllc | Orthotist | 330 W Colfax St Ste 100, Palatine, IL 60067-2538 | 2020-03-25 |
| 1730724394 | Pr Orthotics & Ot LLC | Orthotist | 4711 Golf Rd Ste 1055, Skokie, IL 60076-1272 | 2019-11-07 |
| 1831691104 | Ashley Zinnamon | Orthotist | 1525 E 55th St Ste 204, Chicago, IL 60615-5512 | 2018-03-02 |
| 1194225227 | David B Rotter | Orthotist | 121 Springfield Ave Ste 4, Joliet, IL 60435-6545 | 2018-02-15 |
| 1336651264 | Sandra Jean Schechner | Orthotist | 302 W Rosalie Ln, Palatine, IL 60074-1065 | 2017-11-01 |
| 1356798896 | Rick Allen | Orthotist | 5929 East Riverside Blvd, Rockford, IL 61114-4937 | 2016-05-14 |
| 1124484381 | Hori S Singha | Orthotist | 649 Ridgeview Dr., Mchenry, IL 60050 | 2016-01-04 |
| 1881947091 | Woodfield Ortho Services, LLC | Orthotist | 2401 Kaneville Rd Ste 2, Geneva, IL 60134-2577 | 2012-10-25 |
| 1881964757 | Rinella Orthotics, Inc. | Orthotist | 1890 Silver Cross Blvd # 445, New Lenox, IL 60451-9508 | 2012-01-09 |
| 1306065958 | Erik James Lindholm | Orthotist | 1316 Black Rd, Joliet, IL 60435-3962 | 2007-04-24 |
| Find all providers with the same taxonomy | ||||
| City | SPRINGFIELD |
| Zip Code | 62702 |
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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.