DEREK T KELKENBERG – Physical Therapist, NPI 1336817675

DEREK T KELKENBERG is a healthcare provider. based in Bolingbrook, Illinois. specializing in PHYSICAL THERAPIST IN PRIVATE PRACTICE. The NPI Number for DEREK T KELKENBERG is 1336817675

Main info

Male
5 Years Of Experience
Accepts Medicare Assignment
Name
DEREK T KELKENBERG
NPI
1336817675
Phone
Not provided
Address
790 REMINGTON BLVD
Enumeration Date
1 September 2021
Last Update Date
1 September 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9077433333
Graduation Year
2021 (5 years ago)
PAC ID
3375949415
Group Practice PAC ID
4587551700
Professional Enrollment ID
I20250116000633
Address ID
AK995084143AN2740XPKWY400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience23
Completeness75
Years active:4State licenses:0Digital endpointsOther names

1,885 PHYSICAL THERAPIST IN PRIVATE PRACTICE in SC

Provider Addresses for DEREK T KELKENBERG

  • 790 REMINGTON BLVD

    BOLINGBROOK, IL 604404909

    Phone:

    Type: Mailing

  • 713 W WADE HAMPTON BLVD

    GREER, SC 296501307

    Phone: (864) 479-6084

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-12-01

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking 4 Medicare enrollment records; no due dates published yet.

Enrollment records

4

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20210915000447IPhysical Therapist In Private PracticeSCTBD
I20230301001706IPhysical Therapist In Private PracticeORTBD
I20250116000633IPhysical Therapist In Private PracticeAKTBD
I20251201002221IPhysical Therapist In Private PracticeNYTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
97110Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes911150$0
97140Therapy procedure using manual technique, each 15 minutes29682$0
97530Therapy procedure using functional activities11439$0
97161Evaluation for physical therapy, typically 20 minutes7069$0
97112Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes3619$0
View full utilization report →

Insurance plans in this area (ZIP 60440)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4587551700View full group profile
NameSpecialtyState
Physical Therapist In Private PracticeAK
Physical Therapist In Private PracticeAK
Physical Therapist In Private PracticeAK
-AK
Physical Therapist In Private PracticeAK
-AE
Physical Therapist In Private PracticeAK
Physical Therapist In Private PracticeAK
Physical Therapist In Private PracticeAK
Physical Therapist In Private PracticePA

Reviews

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Frequently asked questions

What NPI should I save for DEREK T KELKENBERG?
Save NPI 1336817675 if you need a stable reference for DEREK T KELKENBERG.
Does this profile mean DEREK T KELKENBERG is currently active?
Yes — DEREK T KELKENBERG appears active in the national provider directory.
What field does DEREK T KELKENBERG work in?
You can think of DEREK T KELKENBERG as practicing within Physical Therapist. Clinical services aligned with this taxonomy classification.
Where is DEREK T KELKENBERG's primary listing?
We display Bolingbrook, Illinois because that is what the record indicates for DEREK T KELKENBERG.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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