Active NPI
Blaine Alan Scholes, PTA
- Physical Therapy Assistant
- Glen Carbon, IL
National Provider Identifier
1760122485
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 160.008256
- Practice address
- 400 S Station Rd
Glen Carbon, IL 62034-2743 - Phone
- (618) 288-5014
- NPI assigned
- Mar 30, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 160.008256 | IL | Primary |
Addresses
Primary practice location
400 S Station Rd
Glen Carbon, IL 62034-2743
Mailing address
400 S Station Rd
Glen Carbon, IL 62034-2743
Phone (618) 288-5014
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 160.008256 | IL | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648598400000",
"number": "1760122485",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 S STATION RD",
"city": "GLEN CARBON",
"state": "IL",
"postal_code": "620342743",
"telephone_number": "618-288-5014"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 S STATION RD",
"city": "GLEN CARBON",
"state": "IL",
"postal_code": "620342743",
"telephone_number": "618-288-5014"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCHOLES",
"first_name": "BLAINE",
"middle_name": "ALAN",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-03-30",
"last_updated": "2022-03-30",
"certification_date": "2022-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IL",
"license": "160.008256",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glen Carbon, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.