Individual provider Active NPI

Frank R Perez, PA-C

  • Physician Assistant
  • Berwyn, IL
National Provider Identifier
1063409035
Registry record updated Dec 14, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
085-002396 Issued in IL
Practice address
7000 Cermak Rd
Berwyn, IL 60402-2112
Phone
(708) 484-8090
NPI assigned
Oct 4, 2005
Last updated
Dec 14, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2018

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 085-002396 IL Primary

Addresses

Primary practice location

7000 Cermak Rd
Berwyn, IL 60402-2112

Mailing address

4738 N Magnolia Ave Apt 2
Chicago, IL 60640-4944
Phone (773) 315-6199

Other practice location 1

1501 S California Ave
Chicago, IL 60608-1732
Phone (773) 257-6051

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
I20050524000246 IL Practitioner - Physician Assistant 1658313382 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hamdard Health AllianceGroup PAC ID 4880680289, 18 clinicians

Practice addresses (Care Compare)

1542 W Devon Ave
Chicago, IL 60660-1344
Phone (630) 835-1430

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
085-002396ILMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Access Community Health Network CurrentSince Apr 8, 2019 Accepting new patients
Access Community Health Network CurrentSince Apr 8, 2019 Accepting new patients
Health Direction Medical Center, S.C. PastSince Jul 25, 2014 Accepting new patients
Juan F Zapata, M.D. LLC Past Accepting new patients

Locations

1501 S California Ave
Chicago, IL 60608
Phone (773) 257-6770

Interoperability endpoints

  • Direct secure messaging: fperez14486@direct.achn.net
  • Direct secure messaging: frank.perez.1@10099.direct.athenahealth.com

Organizations & group practices 6

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.

Hospital & facility affiliations 3

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": "1128384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544745600000",
    "number": "1063409035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4738 N MAGNOLIA AVE APT 2",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606404944",
            "telephone_number": "773-315-6199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7000 CERMAK RD",
            "city": "BERWYN",
            "state": "IL",
            "postal_code": "604022112",
            "telephone_number": "708-484-8090"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1501 S California Ave",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606081732",
            "country_code": "US",
            "telephone_number": "773-257-6051",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "FRANK",
        "middle_name": "R",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-04",
        "last_updated": "2018-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085-002396",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berwyn, IL

Sources for this page

Verify at the official NPI Registry.