Alyce Riley Borkenhagen

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

096005677 Issued in IL

Practice address

609 Glacier TRL
Roselle, IL 60172-1034

Phone

(630) 373-5820

NPI assigned

Mar 13, 2020

Last updated

Nov 2, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1584057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1720614548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 GLACIER TRL",
            "city": "ROSELLE",
            "state": "IL",
            "postal_code": "601721034",
            "telephone_number": "630-373-5820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 GLACIER TRL",
            "city": "ROSELLE",
            "state": "IL",
            "postal_code": "601721034",
            "telephone_number": "630-373-5820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BORKENHAGEN",
        "first_name": "ALYCE",
        "middle_name": "RILEY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-13",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096005677",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0926",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "N/A",
            "affiliation": "N",
            "address_1": "609 Glacier Trl",
            "city": "Roselle",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601721034",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Not-applicable",
            "affiliation": "N",
            "address_1": "609 Glacier Trl",
            "city": "Roselle",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601721034",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "N/A",
            "affiliation": "N",
            "address_1": "609 Glacier Trl",
            "city": "Roselle",
            "state": "IL",
            "country_code": "US",
            "postal_code": "601721034",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Athletic Trainer in Roselle, IL
• Providers in Roselle, IL by specialty
• Athletic Trainer in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.