Emily Randall
Individual provider Active NPI Physical Therapist · Wapella, IL
NPI 1174940522 · NPPES record last updated Mar 24, 2014
Key facts
- NPI
- 1174940522
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 070.020125 (IL)
- Practice address
- 120 N. Locust
Wapella, IL 61777 - Phone
- (217) 876-2600
- NPI assigned
- Mar 24, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 7
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2013
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Comprehensive Therapeutics LTD
Practice addresses (Care Compare)
875 W McKinley Ave
Decatur, IL 62526-3287
Phone (217) 615-2523
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200819000257 | IL | Practitioner - Physical Therapist in Private Practice | 0143646349 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070.020125 | IL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Comprehensive Therapeutics LTD | Physical Therapist | Current |
Accepting new patients |
| Comprehensive Therapeutics LTD | Physical Therapist | Current |
Accepting new patients |
| Fox Rehabilitation Services Il LLC | Physical Therapist | Current |
Accepting new patients |
| Therapeutic Spine and Pain Center, LTD. | Current |
Accepting new patients | |
| McLean County Foot & Ankle, LTD. | Past | Accepting new patients |
Locations
1015 Oconor Ave
La Salle, IL 61301
Phone (224) 616-5446
7 Carnegie Plz
Cherry Hill, NJ 08003
Interoperability endpoints
- https://api.platform.athenahealth.com/11124/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070.020125 | IL | Yes |
Addresses
Primary practice location
120 N. Locust
Wapella, IL 61777
Mailing address
120 N Locust Street
Wapella, IL 61777
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 24, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.