Active NPI
Kimberly Dawn Ecker, PT
- Physical Therapist
- Vienna, IL
National Provider Identifier
1124036165
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- Practice address
- 811 N 1St Street
Vienna, IL 62995 - Phone
- (618) 658-8144
- Fax
- (618) 658-9146
- NPI assigned
- Aug 4, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | IL | Primary |
Addresses
Primary practice location
811 N 1St Street
Vienna, IL 62995
Mailing address
PO Box 95
Vienna, IL 62995-0095
Phone (618) 658-8144
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 048930 | Other | HEALTH ALLIANCE | |
| 59671 | Other | GHP | |
| 1179027 | Other | FIRST HEALTH | |
| 431187 | Other | HEALTHLINK | |
| 4423522 | Other | IL | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070011805 | IL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Real Rehabilitation PC | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Physical Therapist
- Vienna, IL
- NPI 1912030321
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124036165",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 95",
"city": "VIENNA",
"state": "IL",
"postal_code": "629950095",
"telephone_number": "618-658-8144",
"fax_number": "618-658-9146"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "811 N 1ST STREET",
"city": "VIENNA",
"state": "IL",
"postal_code": "62995",
"telephone_number": "618-658-8144",
"fax_number": "618-658-9146"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ECKER",
"first_name": "KIMBERLY",
"middle_name": "DAWN",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTH ALLIANCE",
"identifier": "048930",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHP",
"identifier": "59671",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST HEALTH",
"identifier": "1179027",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "431187",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "4423522",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vienna, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.