Individual provider Active NPI

Lynn P Wellehan

  • Physician Assistant
  • Winnetka, IL
National Provider Identifier
1053063933
Registry record updated Jun 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085009443 Issued in IL
Practice address
1024 Cherry St
Winnetka, IL 60093-2113
Phone
(847) 322-7660
NPI assigned
Jan 22, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 13, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085009443 IL Primary

Addresses

Primary practice location

1024 Cherry St
Winnetka, IL 60093-2113

Mailing address

1024 Cherry St
Winnetka, IL 60093-2113
Phone (847) 322-7660

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
I20230303001885 IL Practitioner - Physician Assistant 0547633067 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians Immediate Care North Chicago LLCGroup PAC ID 8729064159, 256 clinicians

Practice addresses (Care Compare)

1840 N Richmond Rd
McHenry, IL 60051-5416
Phone (779) 704-3075

416 S Milwaukee Ave
Libertyville, IL 60048-2821
Phone (847) 979-1112

4211 N Cicero Ave
Chicago, IL 60641-1651
Phone (773) 794-1000

5961 N Lincoln Ave
Chicago, IL 60659-3758
Phone (312) 702-3923

8630 W Golf Rd
Niles, IL 60714-5600
Phone (847) 299-0009

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

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.

NPI Registry JSON

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

{
    "created_epoch": "1642809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686614400000",
    "number": "1053063933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1024 CHERRY ST",
            "city": "WINNETKA",
            "state": "IL",
            "postal_code": "600932113",
            "telephone_number": "847-322-7660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1024 CHERRY ST",
            "city": "WINNETKA",
            "state": "IL",
            "postal_code": "600932113",
            "telephone_number": "847-322-7660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLEHAN",
        "first_name": "LYNN",
        "middle_name": "P",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-01-22",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085009443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Winnetka, IL

Sources for this page

Verify at the official NPI Registry.