Elias Bousheh

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070027717 Issued in IL

Practice address

5255 E Maryland St
Decatur, IL 62521-9705

Phone

(217) 864-1264

Fax

(217) 864-1828

NPI assigned

Nov 29, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ivyrehab Physical Therapy, Occupational Therapy and Speech Language PAGroup PAC ID 7012997638, 385 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Path

  • Physical Therapist
  • Clinton, IL
  • NPI 1376917187
  Medicare reassignment Care Compare group NPD
• Ivyrehab Physical Therapy, Occupational Therapy & Speech Language Pathology, PLLC

  • Physical Medicine & Rehabilitation Physician
  • New York, NY
  • NPI 1215637699
  NPD

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

{
    "created_epoch": "1543449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694736000000",
    "number": "1902376239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1311 MAMARONECK AVE STE 140",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106055224",
            "telephone_number": "914-294-4050",
            "fax_number": "631-760-8306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5255 E MARYLAND ST",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625219705",
            "telephone_number": "217-864-1264",
            "fax_number": "217-864-1828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOUSHEH",
        "first_name": "ELIAS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-11-29",
        "last_updated": "2023-09-15",
        "certification_date": "2023-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070027717",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lori Ann Born, SLP
• Rachelle L Born
• Blanka Bortely, M.D.
• Nichole L Bosserman
• Kathryn J Bourne
• Mackenzie Marie Bowers, APRN
• David M. Bozarth, RPH
• Caleb David Braasch
• Kristina Kay Bradford, APN
• Elizabeth Bradley

• Physical Therapist in Decatur, IL
• Providers in Decatur, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2023; 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.