ORTHOPEDIC AND SPORTS ENHANCEMENT CENTER, LLC (NPI# 1003900820) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003900820 |
| Entity Type | Organization |
| Organization Name | ORTHOPEDIC AND SPORTS ENHANCEMENT CENTER, LLC |
| Other Organization Name | SPORTS ENHANCEMENT CENTER, LLC |
| Practice Address |
2406 E Empire St Bloomington IL 61704-3630 |
| Practice Telephone | 3096639300 |
| Practice Fax Number | 3096611670 |
| Mailing Telephone | 3096639300 |
| Mailing Fax Number | 3096611670 |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2017-09-12 |
| Authorized Official Name | J. ANTHONY DUSTMAN (PRESIDENT) |
| Authorized Official Telephone | 3096639300 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207X00000X | Orthopaedic Surgery | Allopathic & Osteopathic Physicians | ||
| Y | 174400000X | Specialist | Other Service Providers |
| Other Name | Type Code |
|---|---|
| Sports Enhancement Center, LLC | Former Legal Business Name - Organization |
| Street Address |
2406 E EMPIRE ST |
| City | BLOOMINGTON |
| State | IL |
| Zip Code | 61704-3630 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366552630 | David Mcclure | Physical Therapist | 2406 E Empire St, Bloomington, IL 61704-3630 | 2006-08-30 |
| 1821637927 | Nickolas Allen Rhoades | Nurse Practitioner | 2406 E Empire St, Bloomington, IL 61704-3630 | 2020-01-06 |
| 1306350780 | Angela Sue Birdsell | Nurse Practitioner | 2406 E Empire St, Bloomington, IL 61704-3630 | 2017-11-21 |
| 1427578962 | Daniel Dodd | Radiologic Technologist | 2406 E Empire St, Bloomington, IL 61704-3630 | 2017-06-26 |
| 1811364052 | Cody Wickenhauser | Physical Therapist | 2406 E Empire St, Bloomington, IL 61704-3630 | 2015-08-24 |
| 1710213673 | Bromenn Physician Management Corporation | Internal Medicine | 2406 E Empire St, Bloomington, IL 61704-3630 | 2009-10-28 |
| 1205988458 | Jaclyn Marie Walker | Physical Therapist | 2406 E Empire St, Bloomington, IL 61704-3630 | 2007-01-17 |
| 1225196488 | Millennium Pain Center LLC | Clinic/Center | 2406 E Empire St, Bloomington, IL 61704-3630 | 2006-12-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518430859 | Visionpoint Eye Center LLC | Optometrist | 1107 Airport Road, Bloomington, IL 61704 | 2019-01-09 |
| 1922588235 | Geethu Sabu Makil | Speech-Language Pathologist | 1039 Blueheron Way, Apt#3, Bloomington, IL 61704 | 2018-08-16 |
| 1629596812 | Mental Wellness Center Inc | Counselor | 202 N Prospect Rd Ste 207, Bloomington, IL 61704 | 2017-09-07 |
| 1649798513 | Sarah Goodner | Psychologist | 1704 Royal Pointe Drive, Bloomington, IL 61704 | 2017-08-31 |
| 1346760253 | Elizabeth Devlin | Nurse Practitioner | 25 Long Cove Ct, Bloomington, IL 61704 | 2017-06-21 |
| 1396107918 | Darla Schwertfeger | Specialist/Technologist, Other | 2104 Hedgewood Dr, Bloomington, IL 61704 | 2016-03-23 |
| 1740662949 | Oncology Hematology Associates of Central Illinois | Pharmacy | 3105 Magory Drive, Bloomington, IL 61704 | 2015-06-24 |
| 1821478967 | Kelly R Andrews | Massage Therapist | 4101 Wicker Rd, Bloomington, IL 61704 | 2015-06-03 |
| 1235522582 | All Ways Caring Services, Inc. | In Home Supportive Care | 209 S Prospect Rd, Suite 3e, Bloomington, IL 61704 | 2015-03-11 |
| 1396093977 | Bhawna Gupta | Physical Therapist | 2200 East Washington Street, Bloomington, IL 61704 | 2012-08-29 |
| Find all providers in zip 61704 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578931796 | Gailey Westlund | Specialist | 2120 W Old Shakopee Rd # 3, Bloomington, MN 55431-3000 | 2015-09-03 |
| 1063719169 | Robert A Spicer | Specialist | 5225 W Vernal Pike, Bloomington, IN 47404-9661 | 2011-02-25 |
| 1073815882 | Stephen G Moore | Specialist | 2749 E Covenanter Dr, Bloomington, IN 47401-5454 | 2010-11-30 |
| 1508172099 | Annabelle L Ogerio | Specialist | 1211 Broad Creek Rd, Bloomington, IL 61704-8536 | 2010-08-23 |
| 1366684086 | Sterling Jerel Shores | Specialist | 2301 Ge Rd Apt 12, Bloomington, IL 61704-3425 | 2009-03-26 |
| 1205083417 | Anne J Ford Msw Licsw LLC | Specialist | 9810 Edgewood Rd, Bloomington, MN 55438-1755 | 2008-08-20 |
| 1700066008 | Kab Medical Associates, Inc | Specialist | 2998 S Sare Rd, Bloomington, IN 47401-4330 | 2007-11-05 |
| 1164557799 | Biofeedback Training and Treatment Center, Inc. | Specialist | 5001 American Blvd W Ste 980, Biofeedback Training & Treatment Center, Inc., Bloomington, MN 55437-1164 | 2007-02-22 |
| 1093877151 | Alan B Somers | Specialist | 3800 Commodore Trl, Bloomington, IN 47408-9423 | 2006-12-15 |
| 1174692115 | Taehwan Kim | Specialist | 5342 Paola Cir, Bloomington, MN 55437-1052 | 2006-11-06 |
| Find all providers in BLOOMINGTON | ||||
| City | BLOOMINGTON |
| Zip Code | 61704 |
Please comment or provide details below to improve the information on ORTHOPEDIC AND SPORTS ENHANCEMENT CENTER, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.