Individual provider Active NPI

Alia Antonucci-Alter Edelen, DPT

  • Physical Therapist
  • Raleigh, NC
National Provider Identifier
1356570329
Registry record updated Feb 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
P12202 Issued in NC
Practice address
5838 Six Forks Rd Ste 300
Raleigh, NC 27609-3893
Phone
(919) 782-5954
Fax
(919) 890-5304
NPI assigned
Jul 10, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 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 P12202 NC Primary

Addresses

Primary practice location

5838 Six Forks Rd Ste 300
Raleigh, NC 27609-3893

Mailing address

2122 York Rd Ste 300
Oak Brook, IL 60523-1925
Phone (570) 550-0168

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091120000521 NC Practitioner - Physical Therapist in Private Practice 5698814267 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Brody School of Medicine at East Carolina University, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Activcare Physical Therapy, LLCGroup PAC ID 8628027471, 126 clinicians

Practice addresses (Care Compare)

13200 Strickland Rd
Suite 134
Raleigh, NC 27613-5214
Phone (919) 246-5845

166 Springbrook Ave
Suite 201
Clayton, NC 27520-8520
Phone (919) 535-8461

Merit-based Incentive Payment System (MIPS)

Final score
88.67 of 100Reported as group
Quality
85.21
Promoting interoperability
99
Improvement activities
40
Cost
77.85

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
P12202NCMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Activcare Physical Therapy, LLC Physical Therapist CurrentSince Apr 1, 2016 Accepting new patients

Locations

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

1613 Walnut St
Cary, NC 27511
Phone (919) 290-2799

166 Springbrook Ave
Ste 201
Clayton, NC 27520
Phone (919) 535-8461

3410 Executive Dr
Ste 205
Raleigh, NC 27609
Phone (919) 322-0042

5838 Six Forks Rd
Ste 300
Raleigh, NC 27609
Phone (919) 782-5954

3200 Blue Ridge Rd
Ste 122
Raleigh, NC 27612
Phone (919) 781-0018

Interoperability endpoints

  • Direct secure messaging: alia.edelen.p12@direct.athleticoltd.nextgenshare.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1247184000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706745600000",
    "number": "1356570329",
    "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": "570-550-0168",
            "fax_number": "410-648-4878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5838 SIX FORKS RD STE 300",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276093893",
            "telephone_number": "919-782-5954",
            "fax_number": "919-890-5304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDELEN",
        "first_name": "ALIA",
        "middle_name": "ANTONUCCI-ALTER",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-10",
        "last_updated": "2024-02-01",
        "certification_date": "2024-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NC",
            "license": "P12202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2024; 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.