Individual provider Active NPI

Cynthia Lullo, PA-C

  • Physician Assistant
  • Des Plaines, IL
National Provider Identifier
1063063584
Registry record updated Nov 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085.007432 Issued in IL
Practice address
1 N Broadway St
Des Plaines, IL 60016-2335
Phone
(847) 298-3150
NPI assigned
Sep 25, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 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 085.007432 IL Primary

Addresses

Primary practice location

1 N Broadway St
Des Plaines, IL 60016-2335

Mailing address

1 N Broadway St
Des Plaines, IL 60016-2335
Phone (847) 298-3150

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
I20200210000105 IL Practitioner - Physician Assistant 2769818830 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Access Community Health NetworkGroup PAC ID 9537076112, 182 clinicians
Physicians Immediate Care North Chicago LLCGroup PAC ID 8729064159, 256 clinicians

Practice addresses (Care Compare)

1 N Broadway St
The Genesis Center
Des Plaines, IL 60016-2335
Phone (847) 298-3150

2201 Oak Park Ave
Berwyn, IL 60402-2220
Phone (312) 324-0222

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085.007432ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Access Community Health Network CurrentSince Jan 13, 2020 Accepting new patients
Access Community Health Network CurrentSince Jan 13, 2020 Accepting new patients
Physicians Immediate Care North Chicago LLC CurrentSince Jan 5, 2026 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

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

1 N Broadway St
Des Plaines, IL 60016
Phone (847) 298-3150

335 E Army Trail Rd
Glendale Heights, IL 60139
Phone (630) 226-1006

Interoperability endpoints

  • Direct secure messaging: cgudino14611@direct.achn.net

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": "1569369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700611200000",
    "number": "1063063584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 N BROADWAY ST",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600162335",
            "telephone_number": "847-298-3150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 N BROADWAY ST",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600162335",
            "telephone_number": "847-298-3150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LULLO",
        "first_name": "CYNTHIA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-25",
        "last_updated": "2023-11-22",
        "certification_date": "2023-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085.007432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Des Plaines, IL

Sources for this page

Verify at the official NPI Registry.