Alexander J Blasco-Reyes, DPT
Individual provider Active NPI Physical Therapist · Fox Lake, IL
NPI 1619608809 · NPPES record last updated Oct 11, 2022
Key facts
- NPI
- 1619608809
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 070-026904 (IL)
- Practice address
- 1294 S Route 12
Fox Lake, IL 60020-1950 - Phone
- (847) 973-9440
- NPI assigned
- Jun 20, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Athletico LTD
Practice addresses (Care Compare)
1294 S Route 12
Fox Lake, IL 60020-1950
Phone (847) 973-9440
Merit-based Incentive Payment System (MIPS)
- Final score
- 86.32 of 100
- Quality
- 84.44
- Promoting interoperability
- 99
- Improvement activities
- 40
- Cost
- 70.78
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221025002361 | IL | Practitioner - Physical Therapist in Private Practice | 9436525912 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 070-026904 | IL | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Athletico LTD | Physical Therapist | Current |
Accepting new patients |
| Athletico LTD | Physical Therapist | Current |
Accepting new patients |
Locations
1294 S US Highway 12
Fox Lake, IL 60020
Phone (847) 973-9440
280 N Randall Rd
Lake in the Hills, IL 60156
Phone (847) 854-8219
2122 York Rd
Ste 300
Oak Brook, IL 60523
Phone (630) 575-6250
722 N McLean Blvd
South Elgin, IL 60177
Phone (847) 695-5088
Interoperability endpoints
- alexander.blascoreyes.p9@direct.athleticoltd.nextgenshare.com
- alexander.blascoreyes.p7@direct.athleticoltd.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 070-026904 | IL | Yes |
Addresses
Primary practice location
1294 S Route 12
Fox Lake, IL 60020-1950
Mailing address
2122 York Rd Ste 300
Oak Brook, IL 60523-1925
Phone (630) 575-6200
Other providers in Fox Lake, IL
- Russell E Anderson
- Joshua Tyler Armstrong
- Bailey Behavioral Health, PLLC
- Diane M Bailey Yoder
- Maria Bernal
- Bonnie Mitchell Health Services
- Nancy D Bourke
- Ashley Brown
- Jacob Brown
- Holly Kathleen Buchanan
All providers in Fox Lake, IL · Physical Therapist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 11, 2022. 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.