Brenda Carbajal
Individual provider Active NPI Physician Assistant · Blue Island, IL
NPI 1013523620 · NPPES record last updated Mar 14, 2023
Key facts
- NPI
- 1013523620
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 12200 Western Ave
Blue Island, IL 60406-1398 - Phone
- (708) 631-2781
- NPI assigned
- Sep 18, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Osf Multi-Specialty Group
Practice addresses (Care Compare)
8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050
Hospital & facility affiliations
- Osf Little Company of Mary Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230206000575 | IL | Practitioner - Physician Assistant | 0749652501 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Midwest Express Care 2, Inc | Current |
Accepting new patients | |
| Osf Multi-Specialty Group | Current |
Accepting new patients | |
| Midwest Express Care 2, Inc | Current |
Accepting new patients | |
| Central PA Pharmacy LLC. | Current | Accepting new patients | |
| Cardinal Medical Group, LTD. | Past | Accepting new patients |
Locations (25 of 26)
508 Iaa Dr
Bloomington, IL 61701
Phone (309) 451-2080
12200 Western Ave
Blue Island, IL 60406
Phone (630) 581-5372
2043 S Neil St
Champaign, IL 61820
Phone (217) 337-3852
3653 N Vermilion St
Danville, IL 61832
Phone (217) 554-6827
1 N Logan Ave
Danville, IL 61832
Phone (217) 554-6827
133 Spinder Dr
Ste 4015
East Peoria, IL 61611
2917 W 95th St
Evergreen Park, IL 60805
Phone (708) 907-4355
2779 Volunteer Dr
Ste 201
Galesburg, IL 61401
Phone (309) 345-9400
3315 W 115th St
Unit C
Merrionette Park, IL 60803
Phone (708) 907-4355
1715 N Division St
Ste 5E
Morris, IL 60450
1715 N Division St
Ste 4D
Morris, IL 60450
853 W Jackson St
Morton, IL 61550
211 Greenbriar Dr
Normal, IL 61761
Phone (309) 268-9807
1730 Bradford Ln
Normal, IL 61761
Phone (309) 451-2080
6356 W 95th St
Oak Lawn, IL 60453
Phone (708) 907-4355
5660 W 95th St
Ste 1
Oak Lawn, IL 60453
Phone (708) 499-2273
2911 Columbus St
Ottawa, IL 61350
Phone (815) 431-3410
2301 Court St
Pekin, IL 61554
Phone (303) 308-5100
5209 W War Memorial Dr
Peoria, IL 61615
5905 N Prospect Rd
Peoria, IL 61614
10408 N Centerway Dr
Ste C
Peoria, IL 61615
3626 N Sheridan Rd
Peoria, IL 61604
8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050
841 Broadmeadow Rd
Rantoul, IL 61866
Phone (217) 282-3010
1986 Freedom Pkwy
Ste 1
Washington, IL 61571
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Yes |
Addresses
Primary practice location
12200 Western Ave
Blue Island, IL 60406-1398
Mailing address
1320 W Lombard St
Davenport, IA 52804-2029
Other providers in Blue Island, IL
- Gina Brown
- Frank M Bucki Jr.
- Darlene Jo Buis
- Jeffrey Bzdusek
- Marina Cajas
- Loretta Carpenter
- Natalie Renee Casey
- Julliana Castaneda
- Jonathan Cavanaugh
- Cynthia Cazares
All providers in Blue Island, IL · Physician Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 14, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.