Individual provider Active NPI

Allison Claire Van Staalduinen

  • Physician Assistant
  • Elk Grove Village, IL
National Provider Identifier
1003491242
Registry record updated Nov 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085008443 Issued in IL
Practice address
800 Biesterfield Rd
Elk Grove Village, IL 60007-3361
Phone
(224) 273-3152
NPI assigned
Mar 9, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 4, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 085008443 IL Primary

Addresses

Primary practice location

800 Biesterfield Rd
Elk Grove Village, IL 60007-3361

Mailing address

800 Biesterfield Rd
Elk Grove Village, IL 60007-3361
Phone (224) 273-3152

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211110002483 IL Practitioner - Physician Assistant 3375932445 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
93.41 of 100Reported as group
Quality
86.81
Improvement activities
40
Cost
77.34

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
085008443ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Cepamerica Illinois LLP CurrentSince Jul 17, 2023 Accepting new patients
Cepamerica Illinois LLP CurrentSince Jul 17, 2023 Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

3249 Oak Park Ave
Berwyn, IL 60402
Phone (708) 783-2696

1425 N Randall Rd
Elgin, IL 60123
Phone (224) 783-5437

Organizations & group practices 3

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": "1615248000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635984000000",
    "number": "1003491242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 BIESTERFIELD RD",
            "city": "ELK GROVE VILLAGE",
            "state": "IL",
            "postal_code": "600073361",
            "telephone_number": "224-273-3152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 BIESTERFIELD RD",
            "city": "ELK GROVE VILLAGE",
            "state": "IL",
            "postal_code": "600073361",
            "telephone_number": "224-273-3152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN STAALDUINEN",
        "first_name": "ALLISON",
        "middle_name": "CLAIRE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-09",
        "last_updated": "2021-11-04",
        "certification_date": "2021-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085008443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elk Grove Village, IL

Sources for this page

Verify at the official NPI Registry.