Individual provider Active NPI

Diana Mendoza

  • Physician Assistant
  • Chicago, IL
National Provider Identifier
1003784869
Registry record updated Oct 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085011597 Issued in IL
Practice address
5406 W Fullerton Avenue
Chicago, IL 60639-1427
Phone
(773) 466-7012
NPI assigned
Oct 24, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085011597 IL Primary

Addresses

Primary practice location

5406 W Fullerton Avenue
Chicago, IL 60639-1427

Mailing address

5406 W Fullerton Avenue
Chicago, IL 60639-1427
Phone (773) 466-7012

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
I20260330002723 IL Practitioner - Physician Assistant 8224513007 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

2 Brighton Rd
Suite 300
Clifton, NJ 07012-1645

5406 W Fullerton Ave
Chicago, IL 60639-1427

Hospital & facility affiliations

  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
085011597ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Metro Urgent Care Inc CurrentSince Nov 7, 2025 Accepting new patients
Workfit Physical Therapy LLC CurrentSince Nov 7, 2025 Accepting new patients

Locations

5406 W Fullerton Ave
Chicago, IL 60639
Phone (773) 466-7012

Interoperability endpoints

  • Direct secure messaging: diana.mendoza.1@24714.direct.athenahealth.com

Organizations & group practices 2

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1761264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761264000000",
    "number": "1003784869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5406 W FULLERTON AVENUE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606391427",
            "telephone_number": "773-466-7012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5406 W FULLERTON AVENUE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606391427",
            "telephone_number": "773-466-7012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDOZA",
        "first_name": "DIANA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-10-24",
        "last_updated": "2025-10-24",
        "certification_date": "2025-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085011597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.