Individual provider Active NPI

Carrie A. Randell, P.T.

  • Physical Therapist
  • Peoria, IL
National Provider Identifier
1942220819
Registry record updated Sep 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
070-008500 Issued in IL
Practice address
100 NE Randolph Ave
Peoria, IL 61606-1919
Phone
(309) 624-8575
Fax
(309) 624-8566
NPI assigned
Jul 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2019

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 070-008500 IL Primary

Addresses

Primary practice location

100 NE Randolph Ave
Peoria, IL 61606-1919

Mailing address

530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone (309) 655-2000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191008003617 IL Practitioner - Physical Therapist in Private Practice 0941531701 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Comprehensive Therapeutics LTDGroup PAC ID 8921230137, 324 clinicians

Practice addresses (Care Compare)

1015 Oconor Ave
La Salle, IL 61301-1216
Phone (224) 616-5446

1021 W E St
Belleville, IL 62220-1055
Phone (618) 573-3402

2720 S 14TH St
Pekin, IL 61554-9621
Phone (309) 603-4795

518 W Romeo B Garrett Ave
Peoria, IL 61605-2319
Phone (309) 226-6078

5301 W Everett M Dirksen Pkwy
Peoria, IL 61607-1126
Phone (309) 295-5505

7108 Marine Rd
Edwardsville, IL 62025-4282
Phone (618) 706-9759

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
070-008500ILMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Comprehensive Therapeutics LTD Physical Therapist CurrentSince Oct 1, 2019 Accepting new patients
Comprehensive Therapeutics LTD Physical Therapist CurrentSince Oct 1, 2019 Accepting new patients
Empowerme Rehabilitation Illinois, LLC Physical Therapist CurrentSince Jan 28, 2021 Accepting new patients
Empowerme Rehabilitation Illinois, LLC Physical Therapist CurrentSince Jan 28, 2021 Accepting new patients
Empowerme Wellness Kansas City, LLC Physical Therapist CurrentSince Aug 2, 2021 Accepting new patients
Empowerme Wellness Kansas City, LLC CurrentSince Aug 2, 2021 Accepting new patients

Locations

1021 W E St
Belleville, IL 62220
Phone (618) 233-2095

7108 Marine Rd
Edwardsville, IL 62025
Phone (618) 706-9759

1015 Oconor Ave
La Salle, IL 61301
Phone (224) 616-5446

1335 Strassner Dr
Saint Louis, MO 63144
Phone (314) 673-6723

536 Old Howell Rd
Greenville, SC 29615
Phone (877) 508-3237

Organizations & group practices 6

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": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568851200000",
    "number": "1942220819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-655-2000",
            "fax_number": "309-655-7869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NE RANDOLPH AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616061919",
            "telephone_number": "309-624-8575",
            "fax_number": "309-624-8566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANDELL",
        "first_name": "CARRIE",
        "middle_name": "A.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-20",
        "last_updated": "2019-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070-008500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2019; 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.