Individual provider Active NPI

Stephanie Larios, PA-C

  • Physician Assistant
  • Elgin, IL
National Provider Identifier
1033633946
Registry record updated Mar 7, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085006297 Issued in IL
Practice address
2490 Bushwood Dr
Elgin, IL 60124-7898
Phone
(224) 293-5200
NPI assigned
Aug 1, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2019

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 085006297 IL Primary

Addresses

Primary practice location

2490 Bushwood Dr
Elgin, IL 60124-7898

Mailing address

3211 W Belle Plaine Ave Apt 2a
Chicago, IL 60618-2326

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
I20170916000225 IL Practitioner - Physician Assistant 6608140561 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085006297ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Access Community Health Network CurrentSince Mar 8, 2021 Accepting new patients
Access Community Health Network CurrentSince Mar 8, 2021 Accepting new patients
Access Community Health Network Past Accepting new patients

Locations

600 W Fulton St
Ste 200
Chicago, IL 60661
Phone (312) 526-2000

7200 S Ingleside Ave
Chicago, IL 60619
Phone (773) 324-6942

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1501545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551916800000",
    "number": "1033633946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3211 W BELLE PLAINE AVE APT 2A",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606182326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2490 BUSHWOOD DR",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601247898",
            "telephone_number": "224-293-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARIOS",
        "first_name": "STEPHANIE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-08-01",
        "last_updated": "2019-03-07",
        "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": "085006297",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elgin, IL

Sources for this page

Verify at the official NPI Registry.