NPIMap

Individual provider Active NPI

Marielva Banks, PA-C

  • Medical Physician Assistant
  • Highland, IN
National Provider Identifier
1013431733
Registry record updated Nov 15, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
10002646B Issued in IN
Practice address
10343 Indianapolis Blvd Ste 104
Highland, IN 46322
Phone
(219) 513-4258
NPI assigned
Aug 3, 2017
Last updated
Nov 15, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085006321 IL
Medical Physician Assistant 363AM0700X 10002646B IN Primary

Addresses

Primary practice location

10343 Indianapolis Blvd Ste 104
Highland, IN 46322

Mailing address

10343 Indianapolis Blvd Ste 104
Highland, IN 46322-3639
Phone (219) 513-4258

Other practice location 1

2710 Forest Park Dr
Dyer, IN 46311-2100
Phone (847) 653-0154

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170922002168 IL Practitioner - Physician Assistant 1456625805 Reassigns benefits to 2 organizations
I20190116000307 IN Practitioner - Physician Assistant 1456625805 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Oakland College of Medicine and Surgery, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Esperanza Health CentersGroup PAC ID 2961453105, 53 clinicians

Practice addresses (Care Compare)

2001 S California Ave
Suite 100
Chicago, IL 60608-2486
Phone 7735846200130

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10002646BINMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Esperanza Health Centers CurrentSince Dec 12, 2021 Accepting new patients
Esperanza Health Centers Past Accepting new patients

Locations

2001 S California Ave
Ste 100
Chicago, IL 60608
Phone (773) 640-5785

Interoperability endpoints

  • Direct secure messaging: marielva.banks.1@11903.direct.athenahealth.com

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1501718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573776000000",
    "number": "1013431733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10343 INDIANAPOLIS BLVD STE 104",
            "city": "HIGHLAND",
            "state": "IN",
            "postal_code": "463223639",
            "telephone_number": "219-513-4258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10343 INDIANAPOLIS BLVD STE 104",
            "city": "HIGHLAND",
            "state": "IN",
            "postal_code": "46322",
            "telephone_number": "219-513-4258"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2710 Forest Park Dr",
            "address_purpose": "LOCATION",
            "city": "Dyer",
            "state": "IN",
            "postal_code": "463112100",
            "country_code": "US",
            "telephone_number": "847-653-0154",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BANKS",
        "first_name": "MARIELVA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-03",
        "last_updated": "2019-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085006321",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IN",
            "license": "10002646B",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Highland, IN

Sources for this page

Verify at the official NPI Registry.