Individual provider Active NPI

Yara M Elboghdady, PA-C

  • Physician Assistant
  • Orland Park, IL
National Provider Identifier
1043944796
Registry record updated Apr 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085010140 Issued in IL
Practice address
15300 West Ave Ste 122
Orland Park, IL 60462-4508
Phone
(708) 403-8400
Fax
(708) 403-8492
NPI assigned
Jul 10, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2024

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 085010140 IL Primary
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

15300 West Ave Ste 122
Orland Park, IL 60462-4508

Mailing address

15300 West Ave Ste 122
Orland Park, IL 60462-4508
Phone (708) 403-8400

Other practice location 1

9501 Euclid Ave
Cleveland, OH 44106-4711
Phone (216) 368-3028

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
I20240508002395 IL Practitioner - Physician Assistant 3779924790 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Central Dupage Physician GroupGroup PAC ID 5890696231, 1,087 clinicians

Practice addresses (Care Compare)

15300 W Ave BLDG a
Suite 100
Orland Park, IL 60462-4600
Phone (708) 226-2626

1800 N Main St
Wheaton, IL 60187-3112
Phone (630) 933-4800

Hospital & facility affiliations

  • Northwestern Medicine Central Dupage Hospital Hospital, Winfield, IL, CCN 140242
  • Palos Community Hospital Hospital, Palos Heights, IL, CCN 140062
  • Northwestern Memorial Hospital Hospital, Chicago, IL, CCN 140281

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Central Dupage Physician Group CurrentSince Apr 29, 2024 Accepting new patients

Locations

15300 West Ave
Ste 122
Orland Park, IL 60462
Phone (708) 226-2400

1800 N Main St
Wheaton, IL 60187
Phone (630) 469-0045

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 5

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": "1657411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714003200000",
    "number": "1043944796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15300 WEST AVE STE 122",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604624508",
            "telephone_number": "708-403-8400",
            "fax_number": "708-403-8492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15300 WEST AVE STE 122",
            "city": "ORLAND PARK",
            "state": "IL",
            "postal_code": "604624508",
            "telephone_number": "708-403-8400",
            "fax_number": "708-403-8492"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9501 Euclid Ave",
            "address_purpose": "LOCATION",
            "city": "Cleveland",
            "state": "OH",
            "postal_code": "441064711",
            "country_code": "US",
            "telephone_number": "216-368-3028",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELBOGHDADY",
        "first_name": "YARA",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-10",
        "last_updated": "2024-04-25",
        "certification_date": "2024-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085010140",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orland Park, IL

Sources for this page

Verify at the official NPI Registry.