Individual provider Active NPI

Elysia Tieman, PT, DPT

  • Physical Therapist
  • Bloomington, IN
National Provider Identifier
1114333416
Registry record updated Apr 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
05011545A Issued in IN
Practice address
4264 N Cypress LN Ste 103
Bloomington, IN 47404-8520
Phone
(812) 727-7720
NPI assigned
Jul 8, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X
Physical Therapist 225100000X 05011545A IN Primary

Addresses

Primary practice location

4264 N Cypress LN Ste 103
Bloomington, IN 47404-8520

Mailing address

2122 York Rd Ste 300
Oak Brook, IL 60523-1925
Phone (630) 575-1980

Other practice location 1

640 Birk Rd
Martinsville, IN 46151-6534
Phone (765) 558-2001

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140904002241 IN Practitioner - Physical Therapist in Private Practice 7719105790 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Athletico LTDGroup PAC ID 4789602681, 2,187 clinicians

Practice addresses (Care Compare)

10302 Prosperity Cir
Suite 101
Camby, IN 46113-9002
Phone (317) 548-4172

Merit-based Incentive Payment System (MIPS)

Final score
86.32 of 100Reported as group
Quality
84.44
Promoting interoperability
99
Improvement activities
40
Cost
70.78

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Athletico LTD Physical Therapist Current Accepting new patients
Athletico LTD Physical Therapist CurrentSince Jun 1, 2021 Accepting new patients
Athletico, LTD Physical Therapist CurrentSince Jun 1, 2021 Accepting new patients

Locations

2122 York Rd
Ste 300
Oak Brook, IL 60523
Phone (630) 575-6250

4264 N Cypress Ln
Ste 103
Bloomington, IN 47404
Phone (812) 727-7720

10302 Prosperity Cir
Ste 101
Camby, IN 46113
Phone (317) 548-4172

640 Birk Rd
Martinsville, IN 46151
Phone (765) 558-2001

1505 US Highway 41
Ste A20
Schererville, IN 46375
Phone (219) 322-5560

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": "1404777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1744761600000",
    "number": "1114333416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2122 YORK RD STE 300",
            "city": "OAK BROOK",
            "state": "IL",
            "postal_code": "605231925",
            "telephone_number": "630-575-1980"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4264 N CYPRESS LN STE 103",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474048520",
            "telephone_number": "812-727-7720"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "640 Birk Rd",
            "address_purpose": "LOCATION",
            "city": "Martinsville",
            "state": "IN",
            "postal_code": "461516534",
            "country_code": "US",
            "telephone_number": "765-558-2001",
            "fax_number": "765-343-8093",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIEMAN",
        "first_name": "ELYSIA",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-08",
        "last_updated": "2025-04-16",
        "certification_date": "2025-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IN",
            "license": "05011545A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2025; 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.