Individual provider Active NPI

Ruth Pena, PA-C

  • Medical Physician Assistant
  • New Berlin, WI
National Provider Identifier
1033496930
Registry record updated Jun 17, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
085007424 Issued in IL
Practice address
14555 W National Ave
New Berlin, WI 53151-4494
Phone
(262) 693-4312
NPI assigned
Nov 7, 2011
Last updated
Jun 17, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 17, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 8281-23 WI
Medical Physician Assistant 363AM0700X PA21981 CA
Medical Physician Assistant 363AM0700X 085007424 IL Primary

Addresses

Primary practice location

14555 W National Ave
New Berlin, WI 53151-4494

Mailing address

29373 Network PL
Chicago, IL 60673-1293
Phone (847) 390-5900

Other practice location 1

1441 Branding Ave Ste 310
Downers Grove, IL 60515-5624
Phone (708) 634-0950

Other identifiers 1

IdentifierTypeStateIssuer
100317341MedicaidWI

Electronic endpoints 4

TypeEndpointUseAffiliation
Direct Messaging Address rpena420881@direct.myadvocateaurora.org Direct
Direct Messaging Address rpena420881@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, WI, NC, GA4 enrollments
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 4

Enrollment IDStateProvider typePAC IDDetails
I20250114001035 IL Practitioner - Physician Assistant 2264691906 Reassigns benefits to 1 organization
I20250418002147 WI Practitioner - Physician Assistant 2264691906 Reassigns benefits to 1 organization
I20251002000059 NC Practitioner - Physician Assistant 2264691906 Reassigns benefits to 1 organization
I20260401003756 GA Practitioner - Physician Assistant 2264691906 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

420 E 2ND Ave
Suite 103
Rome, GA 30161-3210

4435 Golf Acres Dr
Charlotte, NC 28208-5947

PO Box
Suite 19305
Charlotte, NC 28219

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. CurrentSince Mar 1, 2025 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Jul 7, 2025 Accepting new patients
Advocate Health and Hospitals Corporation CurrentSince Jan 10, 2025 Accepting new patients
Carolinas Physicians Network Inc CurrentSince Jul 7, 2025 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Mar 1, 2025 Accepting new patients
Advocate Health & Hospitals Corporation CurrentSince Jan 10, 2025 Accepting new patients
Carolinas Physicians Network, Inc Past Accepting new patients
Advocate Health and Hospitals Corporation Past Accepting new patients
High Desert Valley Pediatric Medical Group, Inc. Past Accepting new patients

Locations

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

29373 Network Pl
Chicago, IL 60673

1441 Branding Ave
Ste 310
Downers Grove, IL 60515
Phone (630) 829-1038

14214 Ballantyne Lake Rd
Ste 100
Charlotte, NC 28277
Phone (704) 667-2650

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

Interoperability endpoints

  • Direct secure messaging: rpena420881@direct.myadvocateaurora.org

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1320624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750118400000",
    "number": "1033496930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29373 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731293",
            "telephone_number": "847-390-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14555 W NATIONAL AVE",
            "city": "NEW BERLIN",
            "state": "WI",
            "postal_code": "531514494",
            "telephone_number": "262-693-4312"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1441 Branding Ave Ste 310",
            "address_purpose": "LOCATION",
            "city": "Downers Grove",
            "state": "IL",
            "postal_code": "605155624",
            "country_code": "US",
            "telephone_number": "708-634-0950",
            "fax_number": "708-634-0942",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENA",
        "first_name": "RUTH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-07",
        "last_updated": "2025-06-17",
        "certification_date": "2025-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "8281-23",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA21981",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "IL",
            "license": "085007424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100317341",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rpena420881@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1441 Branding Ave Ste 310",
            "city": "Downers Grove",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605155624",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rpena420881@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "14555 W National Ave",
            "city": "New Berlin",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531514494",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "1441 Branding Ave Ste 310",
            "city": "Downers Grove",
            "state": "IL",
            "country_code": "US",
            "postal_code": "605155624",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "14555 W National Ave",
            "city": "New Berlin",
            "state": "WI",
            "country_code": "US",
            "postal_code": "531514494",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in New Berlin, WI

Sources for this page

Verify at the official NPI Registry.