Individual provider Active NPI

Veronika R Speedwell, PA

  • Physician Assistant
  • Chicago, IL
National Provider Identifier
1053817387
Registry record updated Sep 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085006564 Issued in IL
Practice address
4009 N Broadway St
Chicago, IL 60613-2110
Phone
(773) 275-2586
NPI assigned
Apr 4, 2018
Last updated
Sep 27, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2024

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 085006564 IL Primary

Addresses

Primary practice location

4009 N Broadway St
Chicago, IL 60613-2110

Mailing address

4009 N Broadway St
Chicago, IL 60613-2110

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
I20200706000852 IL Practitioner - Physician Assistant 2365775020 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Rush Medical College of Rush University, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Howard Brown Health CenterGroup PAC ID 1052203155, 52 clinicians

Practice addresses (Care Compare)

4025 N Sheridan Rd
Chicago, IL 60613-2010
Phone (773) 388-1600

6500 N Clark St
Chicago, IL 60626-4002
Phone (773) 388-1600

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085006564ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Howard Brown Health Center CurrentSince Apr 7, 2025 Accepting new patients
Howard Brown Health Center CurrentSince Apr 7, 2025 Accepting new patients
Howard Brown Health Center Past Accepting new patients
Howard Brown Health Center Past Accepting new patients

Locations

4009 N Broadway St
Chicago, IL 60613
Phone (773) 275-2586

4025 N Sheridan Rd
Chicago, IL 60613
Phone (773) 388-1800

Organizations & group practices 4

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": "1522800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1053817387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4009 N BROADWAY ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606132110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4009 N BROADWAY ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606132110",
            "telephone_number": "773-275-2586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPEEDWELL",
        "first_name": "VERONIKA",
        "middle_name": "R",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-04",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085006564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.