Individual provider Active NPI

Raymond S Sebastian, PT

  • Physical Therapist
  • Bloomington, IL
National Provider Identifier
1184862922
Registry record updated Dec 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070.006791 Issued in IL
Practice address
1111 Trinity LN Ste 111
Bloomington, IL 61704-8112
Phone
(309) 663-6461
NPI assigned
Feb 2, 2009
Last updated
Dec 16, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2024

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 070.006791 IL Primary

Addresses

Primary practice location

1111 Trinity LN Ste 111
Bloomington, IL 61704-8112

Mailing address

611 W Park
Fapc
Urbana, IL 61802
Phone (217) 902-6954

Other practice location 1

1437 E College Avenue
Normal, IL 61761
Phone (309) 454-4411

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250114002277 IL Practitioner - Physical Therapist in Private Practice 0244768596 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070.006791ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Carle Health Medical Group CurrentSince Oct 4, 2025 Accepting new patients
Carle West Physician Group Inc CurrentSince Dec 10, 2024 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

1302 Franklin Ave
Ofc
Normal, IL 61761
Phone (309) 268-5918

1437 E College Ave
Normal, IL 61761
Phone (309) 454-4411

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

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1233532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734307200000",
    "number": "1184862922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W PARK",
            "address_2": "FAPC",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "61802",
            "telephone_number": "217-902-6954",
            "fax_number": "217-902-7711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 TRINITY LN STE 111",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617048112",
            "telephone_number": "309-663-6461"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1437 E College Avenue",
            "address_purpose": "LOCATION",
            "city": "Normal",
            "state": "IL",
            "postal_code": "61761",
            "country_code": "US",
            "telephone_number": "309-454-4411",
            "fax_number": "309-454-6951",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SEBASTIAN",
        "first_name": "RAYMOND",
        "middle_name": "S",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-02",
        "last_updated": "2024-12-16",
        "certification_date": "2024-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070.006791",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Dec 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.