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ORTHOPEDIC AND SPORTS ENHANCEMENT CENTER, LLC
NPI 1003900820
Specialist in Bloomington, IL

Active since October 03, 2006
2406 E EMPIRE ST, BLOOMINGTON, IL 61704(309) 663-9300(309) 661-1670 Get Directions Write a Review

NPPES record last updated: September 12, 2017. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Orthopedic And Sports Enhancement Center, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ORTHOPEDIC AND SPORTS ENHANCEMENT CENTER, LLC (NPI 1003900820), doing business as Sports Enhancement Center, Llc, is a healthcare organization registered as a specialist in Bloomington, Illinois and active in the NPI registry since October 2006. The organization lists J. Anthony Dustman, President, as its authorized official.

NPPES Registry Identity

NPI1003900820
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameORTHOPEDIC AND SPORTS ENHANCEMENT CENTER, LLC
Location Address2406 E EMPIRE STBloomington, IL 61704-3630
Mailing Address2406 E Empire StBloomington, IL 61704-3630 · (309) 663-9300 · Fax (309) 661-1670
Phone(309) 663-9300
Fax(309) 661-1670
Organization SubpartNo
Authorized OfficialJ. Anthony DustmanPresident · (309) 663-9300
Enumeration DateOctober 3, 2006
Last NPPES UpdateSeptember 12, 2017
✔ NPI 1003900820 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
Definition
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.
Also ListedOrthopaedic SurgeryTaxonomy 207X00000X
2406 E EMPIRE ST, Bloomington, IL 61704
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Other Names 1

Former Legal Business NameSports Enhancement Center, Llc

Other Identifiers 2

Medicare ID-Type Unspecified420960IL
Medicare NSC4452310001IL

Group Practice 2

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP
Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Orthopedic And Sports Enhancement Center, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

12

Medicare enrollment records show 12 clinicians reassign Medicare billing to Orthopedic And Sports Enhancement Center, LLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 9 within 10 miles. They are listed nearest first.

Clinicians by Medicare Specialty 5

Orthopedic Surgery5
Physical Therapist in Private Practice4
Nurse Practitioner1
Physical Medicine and Rehabilitation1
Podiatry1

Clinicians, nearest first (12)

Bradley Cole, APRN,NP-C
Nurse Practitioner
NPI 1942392675
2406 EAST EMPIRE
Bloomington, IL 61704
(309) 663-9300
✔ PECOS✔ Accepts MedicareSame address
Robert Seidl, MD
Orthopedic Surgery
NPI 1215046313
2406 E. EMPIRE ST.
Bloomington, IL 61704
(309) 663-9300
✔ PECOS✔ Accepts MedicareSame address
John Dustman, M.D.
Orthopedic Surgery
NPI 1760498497
2502 E EMPIRE ST
Bloomington, IL 61704
(309) 663-6461
✔ PECOS0.1 mi
Christopher Byers, PT
Physical Therapist in Private Practice
NPI 1053319392
135 N WILLIAMSBURG DR
Bloomington, IL 61704
(309) 661-8823
0.8 mi
Drew Henneberg
Physical Therapist in Private Practice
NPI 1992129647
135 N WILLIAMSBURG DR
Bloomington, IL 61704
(309) 661-8823
0.8 mi
Emily Sendelbach, DPT
Physical Medicine and Rehabilitation
NPI 1356993828
135 N WILLIAMSBURG DR
Bloomington, IL 61704
(309) 664-9104
✔ PECOS0.8 mi
Emily Whitted, DPT
Physical Therapist in Private Practice
NPI 1447018882
135 N WILLIAMSBURG DR
Bloomington, IL 61704
(309) 661-8823
0.8 mi
Jill Levin, DPT
Physical Therapist in Private Practice
NPI 1821602301
1111 TRINITY LN STE 111
Bloomington, IL 61704
(309) 663-6461
✔ Accepts Medicare0.9 mi
Tyler Neal, D.O.
Orthopedic Surgery
NPI 1336555994
1111 TRINITY LN
Bloomington, IL 61704
(309) 608-5100
✔ PECOS✔ Accepts Medicare0.9 mi
Chris Dangles, M.D.
Orthopedic Surgery
NPI 1669403077
10 DOCTORS PARK
Gibson City, IL 60936
(217) 784-4340
✔ PECOS✔ Accepts Medicare30 mi
Bryce Paschold, D.P.M.
Podiatry
NPI 1003103045
2160 S 1ST AVE
Maywood, IL 60153
(708) 216-4254
✔ PECOS✔ Accepts Medicare111 mi
Nitin Kukkar, MD
Orthopedic Surgery
NPI 1417119918
7410 BLANCO RD STE 101
San Antonio, TX 78216
(210) 401-1515
✔ PECOS929 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Orthopedic And Sports Enhancement Center, LLC's NPI number?

The NPI number for Orthopedic And Sports Enhancement Center, LLC is 1003900820. It was assigned to this organization in the NPPES registry on October 3, 2006. The provider was formerly known as Sports Enhancement Center, LLC.

Where is Orthopedic And Sports Enhancement Center, LLC located?

Orthopedic And Sports Enhancement Center, LLC is located at 2406 E Empire St, Bloomington, IL 61704. The listed phone number is (309) 663-9300.

What is Orthopedic And Sports Enhancement Center, LLC's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Is Orthopedic And Sports Enhancement Center, LLC enrolled in Medicare?

Yes. Orthopedic And Sports Enhancement Center, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Orthopedic And Sports Enhancement Center, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 12 clinicians in 5 Medicare specialties reassign their Medicare billing to Orthopedic And Sports Enhancement Center, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Orthopedic Surgery (5), Physical Therapist in Private Practice (4) and Nurse Practitioner (1). Of these, 2 practice at this address and 9 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Orthopedic And Sports Enhancement Center, LLC was last updated on September 12, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 9 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.