Individual provider Active NPI

Alissa Recker, P.T.

  • Physical Therapist
  • Bloomington, IL
National Provider Identifier
1053850495
Registry record updated Feb 17, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070022820 Issued in IL
Practice address
1111 Trinity LN
Suite 111
Bloomington, IL 61704-8111
Phone
(309) 663-6461
Fax
(309) 661-8107
NPI assigned
Feb 17, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 070022820 IL Primary

Addresses

Primary practice location

1111 Trinity LN
Suite 111
Bloomington, IL 61704-8111

Mailing address

1111 Trinity LN
Suite 111
Bloomington, IL 61704-8111
Phone (309) 663-6461

Other identifiers 2

IdentifierTypeStateIssuer
225100000XOtherTAXONOMY CODE
070022820OtherILSTATE OF ILLINOIS LICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170227001522 IL Practitioner - Physical Therapist in Private Practice 1153605746 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carle West Physician Group IncGroup PAC ID 8921420308, 282 clinicians
Midwest Orthopaedic Center S CGroup PAC ID 8022917715, 45 clinicians
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

2204 Eastland Dr
Bloomington, IL 61704-3567
Phone (309) 663-0222

6000 N Allen Rd
Peoria, IL 61614-3294
Phone (309) 691-1400

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070022820ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Carle Health Care Incorporated CurrentSince Oct 4, 2025 Accepting new patients
Carle West Physician Group Inc CurrentSince Aug 30, 2021 Accepting new patients

Locations

1111 Trinity Ln
Ste 111
Bloomington, IL 61704
Phone (309) 663-6461

2204 Eastland Dr
Bloomington, IL 61704
Phone (309) 662-9461

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1487289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487289600000",
    "number": "1053850495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 TRINITY LN",
            "address_2": "SUITE 111",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617048111",
            "telephone_number": "309-663-6461",
            "fax_number": "309-661-8107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 TRINITY LN",
            "address_2": "SUITE 111",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617048111",
            "telephone_number": "309-663-6461",
            "fax_number": "309-661-8107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RECKER",
        "first_name": "ALISSA",
        "name_prefix": "Dr.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-17",
        "last_updated": "2017-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070022820",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAXONOMY CODE",
            "identifier": "225100000X",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF ILLINOIS LICENSE NUMBER",
            "identifier": "070022820",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.